Risk factors for delayed sputum conversion: A qualitative case study from the person-in-charge of TB program's perspectives.

Background: One of the indicators to determine the success of TB treatment is the conversion of sputum from smear positive to negative. However, several factors can lead to this failure of sputum conversion.

Objectives: To investigate the risk factors for delayed sputum conversion from the person-in-charge (PIC) of the TB program's perspective.

Design and methods: This qualitative case study was conducted on September 7th, 2022. Thirty-one PICs of the TB program from 31 public health centers (Puskesmas) in Bandar Lampung, Indonesia, were recruited purposively. All participants were grouped into three FGDs. Developed semi-structured interview questions were used for data collection. Thematic analysis was used to synthesize and cross-reference emerging topics.

Results: Three themes emerged in our study: (1) individual factors with the sub-themes of medication adherence, education, initial laboratory examination, comorbid disease, nutrition, and lifestyle; (2) environmental factors with the sub-themes of types of support, sources of support, environmental conditions and stigma; and (3) health service factors with the sub-theme of access to health service facilities.

Conclusions: Problems related to TB management are not only the individual's responsibility but need to strengthen support from the environment and health services.