Patient and health system level barriers to and facilitators for tuberculosis treatment initiation in Uganda: a qualitative study

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dc.contributor.authorZawedde‑Muyanja, Stella
dc.contributor.authorManabe, Yukari C.
dc.contributor.authorCattamanchi, Adithya
dc.contributor.authorCastelnuovo, Barbara
dc.contributor.authorKatamba, Achilles
dc.date.accessioned2023-01-18T18:44:31Z
dc.date.available2023-01-18T18:44:31Z
dc.date.issued2022
dc.description.abstractThe 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.en_US
dc.identifier.citationZawedde-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-wen_US
dc.identifier.urihttps://doi.org/10.1186/s12913-022-08213-w
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/7059
dc.language.isoenen_US
dc.publisherBMC health services researchen_US
dc.subjectTuberculosisen_US
dc.subjectTreatment initiationen_US
dc.subjectPatienten_US
dc.subjectHealth systemsen_US
dc.subjectBarriersen_US
dc.subjectFacilitatorsen_US
dc.subjectQualitativeen_US
dc.titlePatient and health system level barriers to and facilitators for tuberculosis treatment initiation in Uganda: a qualitative studyen_US
dc.typeArticleen_US
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