BACKGROUND Assessing healthcare workers’ (HCWs) TB- related knowledge, attitudes, and practices is essential for strengthening the TB prevention and control program. This study aimed to assess TB related knowledge, attitudes, behaviors, and practices regarding TB among HCWs delivering TB services in Jordan and assess their level of satisfaction. OBJECTIVE This study aimed to assess TB related knowledge, attitudes, behaviors, and practices regarding TB among HCWs delivering TB services in Jordan and assess their level of satisfaction. METHODS A cross-sectional study was conducted among 93 HCWs who provide healthcare services to TB patients in 9 TB centers in four governorates in Jordan during the period of June-November 2021. The study questionnaire included information on demographics, TB-related knowledge, attitudes, practices, perceived stigma, and job satisfaction. RESULTS Almost half (45.4%) of physicians, 74% of nurses, and 76.4% of other HCWs had low to moderate TB-related knowledge score. The majority of HCWs (100% of physicians, 92.6% of nurses, and 93.5% of other HCWs) had a positive attitude toward TB and TB patients. The HCWs’ TB-related self-reported practices were good, fair and poor in 38.7%, 29.0% and 32.3% of HCWs, respectively. Almost one fifth of HCWs reported that they have felt stigmatized because of their work around interacting with TB patients. The mean (SD) HCWs’ job satisfaction score on 100 scale was 21.6 (34.8) for physicians, 42.6 (37.2) for nurses, and 47.7 (38.4) for other HCWs. CONCLUSIONS This study identified important knowledge and practice gaps related to TB among HCWs. Based on those gaps, HCWs should receive high quality, tailored, and regular training. Proper training on the clinical guidelines and on the existing infection prevention and control guidelines is of a paramount importance. Follow up on-job supportive supervisory visits will help to ensure improvement of practices.

BACKGROUND The National Tuberculosis Program (NTP) and Tuberculosis (TB) Surveillance System in Jordan have never been evaluated systematically and comprehensively. OBJECTIVE Therefore, this study aimed to determine the gaps in the NTP and the surveillance system in Jordan in 2021 and assess the usefulness and the functionality of TB surveillance. METHODS A concurrent embedded mixed quantitative/qualitative methods study has been conducted to assess the NTP and TB Surveillance System in Jordan. A semi-structured questionnaire was developed based on the Updated CDC Guideline for Evaluating Public Health Surveillance System to collect necessary information from service providers and other stakeholders. RESULTS The NTP and TB Surveillance System face several gaps and challenges in the infrastructure, human resources, equipment, training, NTP functions, surveillance system performance, operational framework, coordination, case findings, and data collection and notification. Regarding the Chest Disease and Migrants Health Directorate (NTP central level) location and accessibility, the building is old and dilapidated, located in the capital's heart, and in a crowded area .Furthermore, infection control at the main Chest Diseases and Migrants Health Directorate is a major concern. It was found that not all TB surveillance System objectives were met in the past. The performed analysis of collected data is neither thorough nor checked for outliers or data quality. The data that the system provides are not well utilized or analyzed thoroughly; accordingly, there were no actions taken as a result of the analysis and interpretation of the data from the TB Surveillance System. There is a delay in TB cases notification received from the parties involved in the TB Surveillance System. The data providers' participation rate in the system is moderate. Moreover, the ethical considerations is a concern; the TB patients do not sign a consent form before giving the data, and in many cases, the patient does not know that they should give their consent prior to obtaining the data from them. CONCLUSIONS Our study showed different gaps in the NTP and TB surveillance system across several areas. The structure of NTP and the clinical expertise of human resources does not support TB elimination. An electronic data collection and notification system is fundamental to facilitate TB case detection, reporting, and follow-up. Infection control measures and practices need to be appropriately applied in all health facilities, and ethical considerations have to be improved to ensure confidentiality and patients' data security. Elimination of tuberculosis in Jordan requires multiple interventions and preparations. The Jordan government should consider TB as a national threat even the country faces low epidemic scenarios. Decision-makers should push the TB epidemic on the national health agenda. The country should spend time and effort to allocate national and international resources for TB control programs. There is a need to identify the high-risk and vulnerable groups and the best means to reach them not only for surveillance purposes but also for service provision.

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BACKGROUND Continuing to smoke tobacco products by tuberculosis (TB) patients and people living with HIV (PLHIV) leads to adverse TB and HIV treatment outcomes, respectively. There are few estimates of tobacco use among patients with TB and PLHIV in countries in the Middle East region where the burden of TB and HIV is also low but highly variable. OBJECTIVE The aim of this study was to determine the prevalence of current tobacco smoking among patients with TB and PLHIV In Jordan and to assess the association between socio-demographic characteristics and current smoking. METHODS We analysed data from the knowledge, attitude, and practice survey conducted in Jordan in 2021. In this survey information about current tobacco smoking was collected from 452 Patients with TB and 152 PLHIV. The data collected on current smoking also included products and frequency of smoking. Multivariable logistic regression was used to assess the sociodemographic characteristics that were independently associated with current smoking. RESULTS The prevalence of current tobacco smoking among patients with TB and PLHIV were 43.8% and 67.8 %, respectively. Cigarettes are the most commonly used tobacco products. The prevalence of current tobacco use was higher among males (71%) when compared to females (22%), those aged >18 years (45%) when compared with those less than 18 years (22%), Jordanians (53%), Syrians (48%) and Palestinians (45%) when compared to people from other nationalities (21%), those experiencing financial difficulties (56%) when compared to those without financial difficulties (33%) and among those employed (47%) than in those unemployed (41%). The prevalence of current tobacco use among PLHIV were higher in males (76%) when compared to females (31%) and those with financial difficulties (73%) when compared to those without financial difficulty (59%). CONCLUSIONS Nearly half of the patients with TB and PLHIV in Jordan were current tobacco smokers. There is an urgent need to introduce/strengthen smoking cessation services under the TB and HIV control programmes in the country.