Investigating factors influencing implementation of tuberculosis infection prevention and control in rural Papua New Guinea

Abstract

Background: Tuberculosis (TB) is a highly transmissible infectious disease killing millions of people yearly. Implementing TB infection prevention and control (TB-IPC) is pivotal to preventing TB transmission in health institutions. This study aimed to investigate diverse stakeholders’ perspectives relating to barriers and strategies of TB-IPC in rural hospitals in Papua New Guinea (PNG). Methods: Multiple qualitative case studies were conducted with 32 key stakeholders with experience in TB services in rural hospitals. Data collection drew on three primary sources to triangulate data: semi-structured interviews, document reviews, and field notes. The data were analysed using hybrid thematic analysis. Results: Our results reveal that key stakeholders perceive multiple interdependent factors that affect TB-IPC. The key emerging themes include strategic planning for and prioritising TB-IPC, governance, leadership, and accountability at the provincial and district level, community attitudes towards TB control, institutional capacity to deliver TB, healthcare workers’ safety, and long-term partnership and integration of TB program. Conclusion: The evidence suggests that a multi-perspective approach to TB-IPC programs is needed for effectively implementing TB-IPC guidelines in healthcare institutions. Interventions focusing on addressing health systems strengthening may improve the implementation of TB-IPC guidelines.