Post-trial perceptions of a symptom-based TB screening intervention in South Africa: implementation insights and future directions for TB preventive healthcare services

Nicole Salazar-Austin, Minja Milovanovic, Nora S West, Molefi Tladi, Grace Link Barnes, Ebrahim Variava, Neil Martinson, Richard E Chaisson, Deanna Kerrigan, Nicole Salazar-Austin, Minja Milovanovic, Nora S West, Molefi Tladi, Grace Link Barnes, Ebrahim Variava, Neil Martinson, Richard E Chaisson, Deanna Kerrigan

Abstract

Background: Tuberculosis is a top-10 cause of under-5 mortality, despite policies promoting tuberculosis preventive therapy (TPT). We previously conducted a cluster randomized trial to evaluate the effectiveness of symptom-based versus tuberculin skin-based screening on child TPT uptake. Symptom-based screening did not improve TPT uptake and nearly two-thirds of child contacts were not identified or not linked to care. Here we qualitatively explored healthcare provider perceptions of factors that impacted TPT uptake among child contacts.

Methods: Sixteen in-depth interviews were conducted with key informants including healthcare providers and administrators who participated in the trial in Matlosana, South Africa. The participants' experience with symptom-based screening, study implementation strategies, and ongoing challenges with child contact identification and linkage to care were explored. Interviews were systematically coded and thematic content analysis was conducted.

Results: Participants' had mixed opinions about symptom-based screening and high acceptability of the study implementation strategies. A key barrier to optimizing child contact screening and evaluation was the supervision and training of community health workers.

Conclusions: Symptom screening is a simple and effective strategy to evaluate child contacts, but additional pediatric training is needed to provide comfort with decision making. New clinic-based child contact files were highly valued by providers who continued to use them after trial completion. Future interventions to improve child contact management will need to address how to best utilize community health workers in identifying and linking child contacts to care.

Trial registration: The results presented here were from research related to NCT03074799 , retrospectively registered on 9 March 2017.

Conflict of interest statement

REC reports receiving consulting fees from Sanofi. All other authors declare that they have no competing interests.

References

    1. Dodd PJ, Yuen CM, Sismanidis C, Seddon JA, Jenkins HE. The global burden of tuberculosis mortality in children: a mathematical modelling study. Lancet Glob Health. 2017;5(9):e898–e906. doi: 10.1016/S2214-109X(17)30289-9.
    1. World Health Organization . Global Tuberculosis Report 2019. Geneva: World Health Organization; 2019.
    1. Smieja M, Marchetti C, Cook D, Smaill FM. Isoniazid for preventing tuberculosis in non-HIV infected persons. Cochrane Database of Systematic Reviews 1999(1). Art. No.: CD001363. 10.1002/14651858.CD001363.
    1. Ayieko J, Abuogi L, Simchowitz B, Bukusi EA, Smith AH, Reingold A. Efficacy of isoniazid prophylactic therapy in prevention of tuberculosis in children: a meta-analysis. BMC Infect Dis. 2014;14:91. doi: 10.1186/1471-2334-14-91.
    1. Dodd PJ, Yuen CM, Becerra MC, Revill P, Jenkins HE, Seddon JA. Potential effect of household contact management on childhood tuberculosis: a mathematical modelling study. Lancet Glob Health. 2018;6(12):e1329–e1338. doi: 10.1016/S2214-109X(18)30401-7.
    1. Stop TB Partnership: UN High-Level Meeting on TB Key Targets & Commitments for 2022. Edited by Stop TB Partnership. Geneva: Stop TB Partnership; 2018.
    1. Massyn N, Peer N, English R, Padarath A, Barron P, Day C. District Health Barometer 2015/16. Durban: Health systems trust; 2016.
    1. WHO . Guidance for national tuberculosis programmes on the management of tuberculosis in children. 2006.
    1. Guidelines for the Management of Tuberculosis in Children [. Access date 5 Aug 2020.
    1. Salazar-Austin N, Cohn S, Barnes GL, Tladi M, Motlhaoleng K, Swanepoel C, Motala Z, Variava E, Martinson N, Chaisson RE. Improving TPT Uptake: A Cluster-Randomized Trial of Symptom-Based Versus Tuberculin Skin Test-Based Screening of Household Tuberculosis Contacts Less than 5 Years of Age. Clin Infect Dis. 2019, [Available on line ahead of print on May 24, 2019]. 10.1093/cid/ciz436.
    1. Szkwarko D, Hirsch-Moverman Y, Du Plessis L, Du Preez K, Carr C, Mandalakas AM. Child contact management in high tuberculosis burden countries: a mixed-methods systematic review. PLoS One. 2017;12(8):e0182185. doi: 10.1371/journal.pone.0182185.
    1. Subedar H. Provincial Guidelines for the Implementation of the Three Streams of the PHC Re-engineering. Guideline 2011. Pretoria: Department of Health; 2012.
    1. Assegaai T, Schneider H. National guidance and district-level practices in the supervision of community health workers in South Africa: a qualitative study. Hum Resour Health. 2019;17(1):25. doi: 10.1186/s12960-019-0360-x.
    1. Mampe T, Schneider H, Reagon H. Effectiveness of Ward based outreach teams in the north West Province: an evaluation. Cape Town: University of the Western Cape; 2016.
    1. Hawe P, Shiell A, Riley T, Gold L. Methods for exploring implementation variation and local context within a cluster randomised community intervention trial. J Epidemiol Community Health. 2004;58(9):788–793. doi: 10.1136/jech.2003.014415.
    1. O'Cathain A, Thomas KJ, Drabble SJ, Rudolph A, Hewison J. What can qualitative research do for randomised controlled trials? A systematic mapping review. BMJ Open. 2013;3(6):e002889. doi: 10.1136/bmjopen-2013-002889.
    1. Tarimo EAM, Ambikile J, Munseri P, Bakari M. Perception of potential harm and benefits of HIV vaccine trial participation: a qualitative study from urban Tanzania. PLoS One. 2019;14(11):e0224831. doi: 10.1371/journal.pone.0224831.
    1. Miles M, Huberman A. Qualitative data analysis: an expanded sourcebook. Thousand Oaks: Sage; 1994.
    1. Roberts K, Dowell A, Nie J-B. Attempting rigour and replicability in thematic analysis of qualitative research data; a case study of codebook development. BMC Med Res Methodol. 2019;19(1):66. doi: 10.1186/s12874-019-0707-y.
    1. Saunders B, Sim J, Kingstone T, Baker S, Waterfield J, Bartlam B, Burroughs H, Jinks C. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant. 2018;52(4):1893–1907. doi: 10.1007/s11135-017-0574-8.
    1. Kamil H, Rachmah R, Wardani E. What is the problem with nursing documentation? Perspective of Indonesian nurses. Int J Afr Nurs Sci. 2018;9:111–114.
    1. Prideaux A. Issues in nursing documentation and record-keeping practice. Br J Nurs. 2011;20(22):1450–1454. doi: 10.12968/bjon.2011.20.22.1450.
    1. Mutshatshi TE, Mamogobo PM, Mbombi MO. Record-keeping: challenges experienced by nurses in selected public hospitals. Curationis. 2018;41(1):e1–e6. doi: 10.4102/curationis.v41i1.1931.
    1. Rispel LC. Special issue: transforming nursing in South Africa. Glob Health Action. 2015;8:28205.
    1. Delobelle P, Rawlinson JL, Ntuli S, Malatsi I, Decock R, Depoorter AM. Job satisfaction and turnover intent of primary healthcare nurses in rural South Africa: a questionnaire survey. J Adv Nurs. 2011;67(2):371–383. doi: 10.1111/j.1365-2648.2010.05496.x.
    1. Mabuza MP, Shumba C. A qualitative exploration of doctors and nurses experiences on the management of tuberculosis and HIV co-infection in a tuberculosis-HIV high burden community in northern KwaZulu-Natal, South Africa. J Public Health Afr. 2018;9(1):770.
    1. Assegaai T, Schneider H. The supervisory relationships of community health workers in primary health care: social network analysis of ward-based outreach teams in Ngaka Modiri Molema District, South Africa. BMJ Global Health. 2019;4(6):e001839. doi: 10.1136/bmjgh-2019-001839.
    1. Triasih R, Robertson CF, Duke T, Graham SM. A prospective evaluation of the symptom-based screening approach to the Management of Children who are Contacts of tuberculosis cases. Clin Infect Dis. 2015;60(1):12–18. doi: 10.1093/cid/ciu748.
    1. Kruk A, Gie RP, Schaaf HS, Marais BJ. Symptom-based screening of child tuberculosis contacts: improved feasibility in resource-limited settings. Pediatrics. 2008;121(6):e1646–e1652. doi: 10.1542/peds.2007-3138.
    1. Horwood C, Voce A, Vermaak K, Rollins N, Qazi S. Experiences of training and implementation of integrated management of childhood illness (IMCI) in South Africa: a qualitative evaluation of the IMCI case management training course. BMC Pediatr. 2009;9:62. doi: 10.1186/1471-2431-9-62.
    1. Rowe AK, Onikpo F, Lama M, Osterholt DM, Rowe SY, Deming MS. A multifaceted intervention to improve health worker adherence to integrated management of childhood illness guidelines in Benin. Am J Public Health. 2009;99(5):837–846. doi: 10.2105/AJPH.2008.134411.
    1. Pandya H, Slemming W, Saloojee H. Health system factors affecting implementation of integrated management of childhood illness (IMCI): qualitative insights from a south African province. Health Policy Plan. 2018;33(2):171–182. doi: 10.1093/heapol/czx154.

Source: PubMed

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