Abstract
BackgroundTuberculosis (TB) infection control at primary healthcare (PHC) level remains problematic, especially in South Africa. Improvements are significantly dependent on healthcare workers’ (HCWs) behaviours, underwriting an urgent need for behaviour change. This study sought to 1) identify factors influencing TB infection control behaviour at PHC level within a high TB burden district and 2) in a participatory manner elicit recommendations from HCWs for improved TB infection control.MethodA qualitative case study was employed. TB nurses and facility managers in the Mangaung Metropolitan District, South Africa, participated in five focus group and nominal group discussions. Data was thematically analysed.ResultsUtilising the Information Motivation and Behaviour (IMB) Model, major barriers to TB infection control information included poor training and conflicting policy guidelines. Low levels of motivation were observed among participants, linked to feelings of powerlessness, negative attitudes of HCWs, poor district health support, and general health system challenges. With a few exceptions, most behaviours necessary to achieve TB risk-reduction, were generally regarded as easy to accomplish.ConclusionsStrategies for improved TB infection control included: training for comprehensive TB infection control for all HCWs; clarity on TB infection control policy guidelines; improved patient education and awareness of TB infection control measures; emphasis on the active role HCWs can play in infection control as change agents; improved social support; practical, hands-on training or role playing to improve behavioural skills; and the destigmatisation of TB/HIV among HCWs and patients.
Highlights
Tuberculosis (TB) infection control at primary healthcare (PHC) level remains problematic, especially in South Africa
Strategies for improved TB infection control included: training for comprehensive TB infection control for all healthcare workers (HCWs); clarity on TB infection control policy guidelines; improved patient education and awareness of TB infection control measures; emphasis on the active role HCWs can play in infection control as change agents; improved social support; practical, hands-on training or role playing to improve behavioural skills; and the destigmatisation of TB/HIV among HCWs and patients
Total eradication of the TB epidemic by 2030 is one of the key health targets of the post-2015 global TB strategy, underlined in the Sustainable Development Goal 3.3 [1, 2]. This target is reflected in the South African National Strategic Plan (NSP) for HIV, STIs and TB 2017–2022, which aims to reduce TB incidence by at least 30%, from 834/100,000 population
Summary
Tuberculosis (TB) infection control at primary healthcare (PHC) level remains problematic, especially in South Africa. Total eradication of the TB epidemic by 2030 is one of the key health targets of the post-2015 global TB strategy, underlined in the Sustainable Development Goal 3.3 [1, 2]. This target is reflected in the South African National Strategic Plan (NSP) for HIV, STIs and TB 2017–2022, which aims to reduce TB incidence by at least 30%, from 834/100,000 population. At the primary healthcare (PHC) level – the entry point for diagnosis, treatment and management of TB and MDRTB in South Africa —the implementation of TB infection control is largely dependent on nurses [16]. Point to poor TB infection control practices at PHC level [7, 16,17,18,19,20,21]
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