Patient and health system level barriers to and facilitators for tuberculosis treatment initiation in Uganda: a qualitative study
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Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
BMC health services research
Abstract
The WHO END TB strategy targets to place at least 90% of all patients diagnosed with Tuberculosis (TB)
on appropriate treatment. In Uganda, approximately 20% of patients diagnosed with TB are not initiated on TB treatment.
We sought to identify the patient and health system level barriers to and facilitators for TB treatment initiation
in Uganda.
Methods: We conducted the study at ten public health facilities (three primary care, four district and three tertiary
referral hospitals). We carried out in-depth interviews with patients diagnosed with TB and key informant interviews
with health managers. In addition, we held focus group discussions with healthcare workers involved in TB care. Data
collection and thematic analysis of transcripts was informed by the Capability, Opportunity, Motivation and Behavior
(COM-B) model. We identified relevant intervention functions using the Behavior Change Wheel.
Results: We interviewed 79 respondents (31 patients, 10 health managers and 38 healthcare workers). Common barriers
at the health facility level included; lack of knowledge about the proportion of patients not initiated on TB treatment
(psychological capability); difficulty accessing sputum results from the laboratory as well as difficulty tracing
patients due to inadequate recording of patient addresses (physical opportunity). At the patient level, notable barriers
included long turnaround time for sputum results and lack of transport funds to return to health facilities (physical
opportunity); limited TB knowledge (psychological capability) and stigma (social opportunity). The most important
facilitators identified were quick access to sputum test results either on the date of first visit (same-day diagnosis) or
on the date of first return and availability of TB treatment (physical opportunity). We identified education, restructuring
of the service environment to improve sputum results turnaround time and enablement to improve communication
of test results as relevant intervention functions to alleviate these barriers to and enhance facilitators for TB
treatment initiation. Conclusion: We found that barriers to treatment initiation existed at both the patient and health facility-level across
all levels of the (Capability, Opportunity and Motivation) model. The intervention functions identified here should be
tested for feasibility.
Description
Keywords
Tuberculosis, Treatment initiation, Patient, Health systems, Barriers, Facilitators, Qualitative
Citation
Zawedde-Muyanja, S., Manabe, Y. C., Cattamanchi, A., Castelnuovo, B., & Katamba, A. (2022). Patient and health system level barriers to and facilitators for tuberculosis treatment initiation in Uganda: a qualitative study. BMC health services research, 22(1), 1-14. https://doi.org/10.1186/s12913-022-08213-w