Uptake of Home-Initiated Tuberculosis Evaluation During Household Contact Investigation in Kampala, Uganda: A Mixed Methods Study
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Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
PeerJ Preprints
Abstract
Home-initiated tuberculosis (TB) evaluation could improve test uptake and linkage
to care among at-risk contacts of active TB index patients. However, there is a need to
systematically explore why contacts accept, decline, or are unable to complete these services. We
sought to describe the barriers to home-based sputum collection as part of enhanced household
contact investigation for TB in Kampala, Uganda.
Methods Using a parallel convergent mixed-methods design, we collected quantitative data
describing home sputum collection among 82 household contacts of active TB patients and
qualitative interviews from a sub-sample of 19 of those contacts. Data were analyzed in parallel
to produce a more complete picture of the underlying barriers to home sputum collection.
Results Men were significantly more likely than women to provide sputum when eligible
(p=0.04). Contacts who reported risk factors for or symptoms of TB but no active cough where
significantly less likely to provide sputum (p=0.05). Education level was not associated with
differences in home sputum collection success. In interviews, contacts pointed to support from
and for the index patient as a facilitator. Contacts were particularly enthusiastic about the
convenience of home-based sputum collection compared to visiting a clinic. Lost or insufficient
sputum containers, difficulty producing sputum on demand, and shame emerged as barriers to
collecting sputum at home.
Conclusions Uptake of sputum collection might be improved by addressing opportunity barriers
prior to the visit, possibly through equipment checklists and improved community health worker training. More research is needed on the effects of TB stigma on willingness to produce sputum,
even in the privacy of one’s own home.
Description
Keywords
Tuberculosis, Household Contact, Investigation
Citation
Armstrong-Hough, M., Ggita, J., Turimumahoro, P., Meyer, A., Ochom, E., Katamba, A., & Davis, J. L. (2017). Uptake of home-initiated tuberculosis evaluation during household contact investigation in Kampala, Uganda: A mixed-methods study. PeerJ Preprints, 5, e3384v1. https://doi.org/10.7287/peerj.preprints.3384v1