Assessment of barriers and facilitators to the implementation of Tuberculosis Screening Strategy among health workers in public health facilities in Jinja City, Uganda

Abstract

Uganda is ranked among the 30 high Tuberculosis (TB) disease burden countries globally. Jinja city is one of the 10 high-burden TB regions in Uganda, and has been reporting rising cases of TB with a high prevalence. Uganda developed a TB symptom screening guideline for health workers to improve TB case finding. Objective: We assessed the proportion of clients screened for TB and barriers and facilitators to the implementation of TB screening strategy in public health facilities in Jinja City. Methods This was a mixed methods study conducted in 20 public health facilities (HF) in Jinja City between October and November 2022. Exit interviews were administered to 416 patients, to assess whether they were screened for the TB symptoms that is cough, excessive night sweats, noticeable weight loss, and persistent fever. A patient was considered screened for TB if he/she was asked about all 4 TB symptoms. Data were collected using Kobo collect and analysed in STATA version 14. Logistic regression was used to determine the relationship between TB screening and health facility characteristics. In addition, key informant interviews were conducted among 31 health care workers to explore facilitators and barriers to TB screening in health facilities. At each HF, a key informant interview guide was administered to the health facility in-charge and TB focal person as well as the City Health Officer and TB supervisor. The interviews were audio recorded and transcribed verbatim and thematic analysis done. Results Of the 416 patient participants recruited majority 66.8% (278/416) were from regional hospital and HCIV level. The fully screened clients across all facilities were 6% (24/416). Majority of these 19/24 (79.1%) were screened at Hospital and HCIVs level compared to lower health facilities IIIs and IIs, P-value (0.038) and Fisher s exact test 0.051. OPD departments screened the most patients 14/24 (58.3%) across all HF compared to other departments. Health workers reported knowledge gap, lack of facilitation, heavy workload and stock-outs of TB equipment and supplies as barriers to adequate TB screening. Training, good leadership and incentives were reported as the facilitators for TB screening. Conclusion and recommendation TB screening is not adequately done in all public health facilities in in Jinja City. Barriers to TB screening such as heavy workload, lack of knowledge and stock-outs of TB equipment were identified exist at all levels of the health facilities. The facilitators identified such as good leadership, training in TB management exist in a few facilities. The health workers at high-level facilities (Hospital and HCIVs) were more likely to implement TB screening than those at and lower level (HCIII and HCIIs) facilities in Jinja City. It is important to engage all stakeholders to support TB screening, and empower health workers’ capacity through re-orientation and training on the importance of symptom TB screening to improve TB disease detection in Jinja City.