Structural barriers to implementing recommended tuberculosis preventive treatment in primary care clinics in rural South Africa

Chandra, Divya K; Moll, Anthony; Altice, Frederick L.; DiDomizio, Elizabeth; Andrews, Laurie; Shenoi, Sheela

doi:10.1080/17441692.2021.1892793

Cited by 7 publications

(5 citation statements)

References 58 publications

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“…This misconception might be due to the lack of TPT information in the community or unclear explanations of the TPT effectiveness from healthcare providers. Limited TPT knowledge among healthcare providers is a factor hindering TPT initiation in many settings such as South Africa (35,36), Dominican Republic (31), Kenya (5). These ndings suggest that more comprehensive TPT community awareness campaigns and TPT training for healthcare providers in charge of TB are essential to tackle this barrier.…”

Section: Discussionmentioning

confidence: 99%

They do not have symptoms – Why do they need to take medicines? Challenges in tuberculosis preventive treatment among children in Cambodia: a qualitative study

An¹,

Teo

Huot

et al. 2022

Preprint

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Background: Latent tuberculosis (TB) infection has been known as seedbeds for TB disease later in life. The interruption from latent TB infection to TB disease can be done through TB preventive treatment (TPT). In Cambodia, only about 83.0% of children under five years old who were the household contacts to bacteriologically confirmed TB cases were initiated with TPT in 2020. Scientific studies of context-specific operational challenges in TPT provision and uptake among children are scarce, particularly in high TB-burden countries. This study identified challenges in TPT provision and uptake among children in Cambodia from the perspective of healthcare providers and caregivers. Methods: Between October and December 2020, we conducted in-depth interviews with four operational district TB supervisors, four clinicians and four nurses in charge of TB in referral hospitals, four nurses in charge of TB in health centers, and 28 caregivers with children currently or previously on TB treatment, on TPT, and those who refused TPT for their eligible children. Data were audio recorded along with field notetaking. After verbatim transcription, data analyses were performed using a thematic approach. Results: The mean age of healthcare providers and caregivers were 40.19 years (SD 12.0) and 47.9 years (SD 14.6), respectively. The majority of healthcare providers (93.8%) were male, and 75.0% of caregivers were female. More than one-fourth of caregivers were grandparents, and 25.0% of the caregivers had no formal education. Identified key barriers to TPT implementation among children included TPT side effects, poor adherence to TPT, poor understanding of TPT among caregivers, TPT risk perception among caregivers, child-unfriendly formula, TPT supply-chain issues, caregivers’ concern about the effectiveness of TPT, being non-parental caregivers, and poor community engagement. Conclusion: The national TB program should invest in capacity building on TPT among healthcare providers, ensuring appropriate mechanisms to ensure adequate TPT drug supply, and improving community awareness of TPT. These context-specific interventions will play a crucial role in expanding the TPT program to interrupt the development from latent TB infection to active and ultimately lead to ending TB in the country.

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Section: Discussionmentioning

confidence: 99%

They do not have symptoms – Why do they need to take medicines? Challenges in tuberculosis preventive treatment among children in Cambodia: a qualitative study

An¹,

Teo

Huot

et al. 2022

Preprint

View full text Add to dashboard Cite

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“…17 Similarly, a mixed-methods study among children and adults living with HIV in India observed older age associated with TPT initiation, identified shortages, lack of education (for both HCW and patients), and loss to follow-up as reasons for noninitiation. 18 We observed lower TPT completion than some adult studies in SSA, which may reflect differences between YWHIV and adults, 19–22 different sites of TPT delivery (such as pharmacist-initiated TPT), 22 or cohorts with more advanced disease. 19,20 Support groups for YWHIV could facilitate messaging to improve TPT completion, mirroring effectiveness of peer groups on retention in HIV care.…”

Section: Discussionmentioning

confidence: 73%

“…18 We observed lower TPT completion than some adult studies in SSA, which may reflect differences between YWHIV and adults, 19–22 different sites of TPT delivery (such as pharmacist-initiated TPT), 22 or cohorts with more advanced disease. 19,20 Support groups for YWHIV could facilitate messaging to improve TPT completion, mirroring effectiveness of peer groups on retention in HIV care. 29 YWHIV with longer time in care had a higher likelihood of TPT initiation and completion.…”

Section: Discussionmentioning

confidence: 73%

“…A 2016 systematic review in predominantly high-income countries among adults noted that approximately 50% of people with medical indications (such as HIV) completed TPT. 16 Recent studies in SSA estimated TPT initiation rates of 14%-58% [17][18][19][20] and completion rates ranging from 40% to 94%. [20][21][22][23] A recent evaluation of TPT use among children (aged younger than 15 years) newly enrolled in HIV care in Kenya observed 68% TPT initiation and 78% TPT completion.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Tuberculosis Preventative Therapy Initiation and Completion Among Adolescents and Young Adults Living With HIV in Kenya

Black¹,

LaCourse

Njuguna

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background:Tuberculosis is the leading cause of death among adolescents and young adults living with HIV (YWHIV) and their heightened risk warrants deeper understanding of utilization of tuberculosis-prevention measures within HIV care.Setting:Retrospective study using clinic surveys and medical record data from 86 Kenyan HIV clinics.Methods:Clinic surveys obtained information on tuberculosis preventive therapy (TPT) services. Medical records of YWHIV were abstracted. Bivariate and multivariate analyses used generalized linear models to determine individual-level and clinic-level cofactors of TPT initiation and completion.Results:Among 10,328 eligible YWHIV, 4337 (42.0%) initiated TPT. Of 3295 with ≥6 months follow-up, 1774 (53.8%) completed TPT. A lower patient-to-staff ratio was a clinic-level cofactor of TPT initiation (P = 0.044) and completion (P = 0.004); designated adolescent areas were associated with TPT initiation {prevalence ratio 2.05 [95% confidence interval (CI): 1.46 to –2.88]}. Individual cofactors of TPT initiation included younger age at HIV-care enrollment [relative risk (RR) 0.85 (95% CI: 0.80 to 0.90)] and antiretroviral therapy (ART) duration [1–2 vs. <1 year RR 1.31 (95% CI: 1.18 to 1.45)]. TPT completion was associated with younger age [RR 0.91 (95% CI: 0.85 to 0.98)] and ART duration [2–5 vs. <1 year RR 1.27 (95% CI: 1.03 to 1.57)]. In multivariate models, TPT initiation was associated with younger age and ART duration [1–2 vs. 1 year; adjusted RR 1.30 (95% CI: 1.16 to 1.46)] and TPT completion with ART duration [2–5 vs. 1 year adjusted RR 1.23 (95% CI: 0.99 to 1.52)].Conclusion:Over half of YWHIV did not initiate and >40% did not complete TPT, with distinct clinic-level and individual-level cofactors. Approaches to enhance adolescent-friendly infrastructure and support older YWHIV are necessary to improve TPT use.

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“…Unclear explanations about TPT from healthcare providers could raise a concern about the TPT's effectiveness in preventing TB disease among caregivers and may lead to low TPT acceptance for their children. Limited TPT knowledge among healthcare providers is a factor hindering TPT initiation in many settings, such as South Africa [34,35], Dominican Republic [36], and Kenya [13]. These findings suggest that more comprehensive TPT training for healthcare providers in charge of TB along with TPT community awareness campaigns are essential to tackle this barrier.…”

Section: Discussionmentioning

confidence: 99%

They do not have symptoms – why do they need to take medicines? Challenges in tuberculosis preventive treatment among children in Cambodia: a qualitative study

Teo²,

Huot³

et al. 2023

BMC Pulm Med

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Background Latent tuberculosis (TB) infection has been known as a seedbed for TB disease later in life. The interruption from latent TB infection to TB disease can be done through TB preventive treatment (TPT). In Cambodia, only 40.0% of children under five years old who were the household contacts to bacteriologically confirmed TB cases were initiated with TPT in 2021. Scientific studies of context-specific operational challenges in TPT provision and uptake among children are scarce, particularly in high TB-burden countries. This study identified challenges in TPT provision and uptake among children in Cambodia from the perspective of healthcare providers and caregivers. Methods Between October and December 2020, we conducted in-depth interviews with four operational district TB supervisors, four clinicians and four nurses in charge of TB in referral hospitals, four nurses in charge of TB in health centers, and 28 caregivers with children currently or previously on TB treatment or TPT, and those who refused TPT for their eligible children. Data were audio recorded along with field notetaking. After verbatim transcription, data analyses were performed using a thematic approach. Results The mean age of healthcare providers and caregivers were 40.19 years (SD 12.0) and 47.9 years (SD 14.6), respectively. Most healthcare providers (93.8%) were male, and 75.0% of caregivers were female. More than one-fourth of caregivers were grandparents, and 25.0% had no formal education. Identified key barriers to TPT implementation among children included TPT side effects, poor adherence to TPT, poor understanding of TPT among caregivers, TPT risk perception among caregivers, TPT’s child-unfriendly formula, TPT supply-chain issues, caregivers’ concern about the effectiveness of TPT, being non-parental caregivers, and poor community engagement. Conclusion Findings from this study suggest that the national TB program should provide more TPT training to healthcare providers and strengthen supply chain mechanisms to ensure adequate TPT drug supplies. Improving community awareness of TPT among caregivers should also be intensified. These context-specific interventions will play a crucial role in expanding the TPT program to interrupt the development from latent TB infection to active and ultimately lead to ending TB in the country.

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Structural barriers to implementing recommended tuberculosis preventive treatment in primary care clinics in rural South Africa

Cited by 7 publications

References 58 publications

They do not have symptoms – Why do they need to take medicines? Challenges in tuberculosis preventive treatment among children in Cambodia: a qualitative study

They do not have symptoms – Why do they need to take medicines? Challenges in tuberculosis preventive treatment among children in Cambodia: a qualitative study

Tuberculosis Preventative Therapy Initiation and Completion Among Adolescents and Young Adults Living With HIV in Kenya

They do not have symptoms – why do they need to take medicines? Challenges in tuberculosis preventive treatment among children in Cambodia: a qualitative study

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