Acceptability of decentralizing childhood tuberculosis diagnosis in low-income countries with high tuberculosis incidence: Experiences and perceptions from health care workers in Sub-Saharan Africa and South-East Asia.

Autor:	Joshi B; National Institute for Health and Medical Research (INSERM), Research Institute for Sustainable Development (IRD), University of Bordeaux, Bordeaux Population Health Centre, Bordeaux, France., De Lima YV; Instituto Nacional de Saúde, Marracuene, Mozambique., Massom DM; IRD, Yaoundé, Cameroon., Kaing S; Institut Pasteur du Cambodge, Epidemiology and Public Health Unit, Phnom Penh, Cambodia., Banga MF; Programme PAC-CI, Site de l'ANRS Abidjan, Abidjan, Côte d'Ivoire., Kamara ET; Solthis, Freetown, Sierra Leone., Sesay S; Solthis, Freetown, Sierra Leone., Borand L; Institut Pasteur du Cambodge, Epidemiology and Public Health Unit, Phnom Penh, Cambodia., Taguebue JV; Fondation Chantal Biya, Centre Mère-Enfant, Yaoundé, Cameroon., Moh R; Programme PAC-CI, Site de l'ANRS Abidjan, Abidjan, Côte d'Ivoire., Khosa C; Instituto Nacional de Saúde, Marracuene, Mozambique., Breton G; Solthis, Freetown, Sierra Leone., Mwanga-Amumpaire J; Epicentre Mbarara Research Centre, Mbarara, Uganda., Bonnet M; University of Montpellier, IRD,-INSERM, TRANSVIH MI, Montpellier, France., Wobudeya E; MUJHU Research Collaboration, MU-JHU Care Limited, Kampala, Uganda., Marcy O; National Institute for Health and Medical Research (INSERM), Research Institute for Sustainable Development (IRD), University of Bordeaux, Bordeaux Population Health Centre, Bordeaux, France., Orne-Gliemann J; National Institute for Health and Medical Research (INSERM), Research Institute for Sustainable Development (IRD), University of Bordeaux, Bordeaux Population Health Centre, Bordeaux, France.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2023 Oct 11; Vol. 3 (10), pp. e0001525. Date of Electronic Publication: 2023 Oct 11 (Print Publication: 2023).
DOI:	10.1371/journal.pgph.0001525
Abstrakt:	Decentralizing childhood tuberculosis services, including diagnosis, is now recommended by the WHO and could contribute to increasing tuberculosis detection in high burden countries. However, implementing microbiological tests and clinical evaluation could be challenging for health care workers (HCWs) in Primary Health Centers (PHCs) and even District Hospitals (DHs). We sought to assess the acceptability of decentralizing a comprehensive childhood tuberculosis diagnosis package from HCWs' perspective. We conducted implementation research nested within the TB-Speed Decentralization study. HCWs from two health districts of Cambodia, Cameroon, Côte d'Ivoire, Mozambique, Sierra Leone, and Uganda implemented systematic screening, nasopharyngeal aspirates (NPA) and stool sample collection with molecular testing, clinical evaluation and chest X-ray (CXR) interpretation. We investigated their experiences and perceptions in delivering the diagnostic package components in 2020-21 using individual semi-structured interviews. We conducted thematic analysis, supported by the Theoretical Framework of Acceptability. HCWs (n = 130, 55% female, median age 36 years, 53% nurses, 72% PHC-based) perceived that systematic screening, although increasing workload, was beneficial as it improved childhood tuberculosis awareness. Most HCWs shared satisfaction and confidence in performing NPA, despite procedure duration, need to involve parents/colleagues and discomfort for children. HCWs shared positive attitudes towards stool sample-collection but were frustrated by delayed stool collection associated with cultural practices, transport and distance challenges. Molecular testing, conducted by nurses or laboratory technicians, was perceived as providing quality results, contributing to diagnosis. Clinical evaluation and diagnosis raised self-efficacy issues and need for continuous training and clinical mentoring. HCWs valued CXR, however complained that technical and logistical problems limited access to digital reports. Referral from PHC to DH was experienced as burdensome. HCWs at DH and PHC-levels perceived and experienced decentralized childhood tuberculosis diagnosis as acceptable. Implementation however could be hampered by feasibility issues, and calls for innovative referral mechanisms for patients, samples and CXR. Competing Interests: The authors have declared that no competing interests exist. (Copyright: © 2023 Joshi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze:	MEDLINE
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