Reasons for poor uptake of TB preventive therapy in South Africa.

IF 1.3 Q4 RESPIRATORY SYSTEM Public Health Action Pub Date : 2022-12-21 DOI:10.5588/pha.22.0030
D P Baloyi, M G Anthony, K A Meyerson, S Mazibuko, D Wademan, L Viljoen, H Myburgh, K du Preez, M Osman, Y Hirsch-Moverman, S Charalambous, H Hausler, A C Hesseling, G Hoddinott
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引用次数: 4

Abstract

Background: South Africa has one the highest TB and HIV burdens globally. TB preventive therapy (TPT) reduces the risk of TB disease and TB-related mortality in adults and children living with HIV and is indicated for use in TB-exposed HIV-negative individuals and children. TPT implementation in South Africa remains suboptimal.

Methods: We conducted a pragmatic review of TPT implementation using multiple data sources, including informant interviews (n = 134), semi-structured observations (n = 93) and TB patient folder reviews in 31 health facilities purposively selected across three high TB burden provinces. We used case descriptive analysis and thematic coding to identify barriers and facilitators to TPT implementation.

Results: TPT programme implementation was suboptimal, with inadequate monitoring even in health districts with well-functioning TB services. Health workers reported scepticism about TPT effectiveness, deprioritised TPT in practice and expressed divergent opinions about the cadres of staff responsible for implementation. Service- and facility-level barriers included ineffective contact tracing, resource shortages, lack of standardised reporting mechanisms and insufficient patient education on TPT. Patient-level barriers included socio-economic factors.

Conclusions: Improving TPT implementation will require radically simplified and more feasible systems and training for all cadres of health workers. Partnership with communities to stimulate demand driven service uptake can potentially facilitate implementation.

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南非结核病预防治疗使用率低的原因。
背景:南非是全球结核病和艾滋病毒负担最高的国家之一。结核病预防治疗(TPT)可降低感染艾滋病毒的成人和儿童患结核病和结核病相关死亡率的风险,并适用于暴露于结核病的艾滋病毒阴性个人和儿童。南非的TPT实施情况仍不理想。方法:我们使用多种数据来源对TPT实施情况进行了务实的回顾,包括信息者访谈(n = 134)、半结构化观察(n = 93)和结核病患者文件夹回顾,这些数据来自三个结核病高负担省份的31家卫生机构。我们使用案例描述性分析和主题编码来确定TPT实现的障碍和促进因素。结果:TPT规划的实施并不理想,即使在结核病服务运转良好的卫生区,监测也不充分。卫生工作者报告对TPT的有效性持怀疑态度,在实践中不重视TPT,并对负责执行的工作人员的干部表达了不同的意见。服务和设施层面的障碍包括接触者追踪无效、资源短缺、缺乏标准化报告机制以及TPT患者教育不足。患者层面的障碍包括社会经济因素。结论:改善TPT的实施需要从根本上简化和更可行的系统,并对所有卫生工作者干部进行培训。与社区建立伙伴关系,以刺激需求驱动的服务吸收,可能会促进实施。
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来源期刊
Public Health Action
Public Health Action RESPIRATORY SYSTEM-
自引率
0.00%
发文量
29
期刊介绍: Launched on 1 May 2011, Public Health Action (PHA) is an official publication of the International Union Against Tuberculosis and Lung Disease (The Union). It is an open access, online journal available world-wide to physicians, health workers, researchers, professors, students and decision-makers, including public health centres, medical, university and pharmaceutical libraries, hospitals, clinics, foundations and institutions. PHA is a peer-reviewed scholarly journal that actively encourages, communicates and reports new knowledge, dialogue and controversy in health systems and services for people in vulnerable and resource-limited communities — all topics that reflect the mission of The Union, Health solutions for the poor.
期刊最新文献
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