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Abstract
IntroductionTB contact tracing rates remain low in high burden settings and reasons for this are not well known. We describe factors that influence health care workers' (HCW) implementation of TB contact tracing (CT) in a high TB burden district of Botswana.MethodsData were collected using questionnaires and in-depth interviews in 31 of the 52 health facilities in Kweneng East Health District. Responses were summarized using summary statistics and comparisons between HCW groups were done using parametric or non-parametric tests as per normality of the data distribution.ResultsOne hundred and four HCWs completed questionnaires. Factors that influenced HCW TB contact tracing were their knowledge, attitudes and practices as well as personal factors including decreased motivation and lack of commitment. Patient factors included living further away from the clinic, unknown residential address and high rates of migration and mobility. Administrative factors included staff shortages, lack of transport, poor reporting of TB cases and poor medical infrastructure e.g. suboptimal laboratory services. A national HCW strike and a restructuring of the health system emerged as additional factors during in-depth interviews of TB coordinators.ConclusionMultiple factors lead to poor TB contact tracing in this district. Interventions to increase TB contact tracing will be informed by these findings.
Highlights
TB contact tracing rates remain low in high burden settings and reasons for this are not well known
A total of 160 questionnaires were disseminated to health care workers' (HCW) around Kweneng East Health District
In discussions with the District TB coordinators, the coordinators commented that the TB contact tracing rate was low in the 31 facilities sampled in this study as compared to the 21 facilities that were not sampled[7]
Summary
TB contact tracing rates remain low in high burden settings and reasons for this are not well known. We describe factors that influence health care workers' (HCW) implementation of TB contact tracing (CT) in a high TB burden district of Botswana. A recent study from Botswana reported a new TB diagnosis yield of 2.2% from CT of household contacts of pediatric TB cases [1] This is very similar to the pooled yield of 2.3% described in a meta-analysis of 23 adult TB case-focused studies [2]. In high burden TB settings the factors that adversely influence implementation of CT are poorly described. It is likely that many of these factors play a role in the implementation of CT in high burden TB settings
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