Due to their occupational exposure in health care settings, health care workers (HCW) have increased risk of Mycobacterium tuberculosis infection. They face challenges to remain up-to-date with evidence-based clinical practices and translate educational information into actions in infection control practices. Our purpose was to examine this "knowledge-action" gap about how HCWs understand their occupational M. tuberculosis risk and use recommended infection control measures in clinical practices in the Dominican Republic (DR). We conducted 10 focus groups with 40 physicians and nurses at two tertiary-level DR institutions. Using grounded theory methods, we developed a theoretical model to describe the decision-making process related to adherence to M. tuberculosis infection control measures in clinical practice. Findings highlight intrinsic and extrinsic factors that influenced the observed knowledge-action gap related to M. tuberculosis infection control practices in two DR health institutions.

Objective To describe health care workers' practical recommendations for strengthening adherence to Mycobacterium tuberculosis infection control practices in their health institutions and elsewhere across the Dominican Republic. Methods In this qualitative study, 10 focus groups, with a total of 40 clinicians (24 physicians, 16 nurses), were conducted in 2016 at two tertiary-level institutions in the Dominican Republic. Grounded theory guided the analysis to expand on health care workers' recommendations for empowering clinicians to adhere to M. tuberculosis infection control practices. To ensure reliability and validity, the authors analyzed data and incorporated both peer debriefing with qualitative experts and participant feedback or validation on the final themes. Results Six emerging themes were described: 1) education and training; 2) administrative policy; 3) infrastructure policy; 4) economic allocations; 5) research; and 6) public health policy. Conclusions Future efforts may combine the health care workers' recommendations with evidence-based strategies in M. tuberculosis infection control in low-resource settings. This could pave the way for interventions that empower health care workers in their application of M. tuberculosis infection control measures in clinical practice.

Current challenges in TB control efforts, such as an unprepared public health system leadership and infrastructure and an overwhelmed health care workforce, will require novel approaches, practices, and renewed political commitment to maintain sustainable TB programs.We described proposed recommendations that may strengthen health system preparedness for optimal TB control across low-and middle-income countries: n Ensuring leadership and governance for sustainable national health care budgets n Building networks of community stakeholders n Supporting high-quality health care workforce training and safe workplace environments n Using digital health interventions for TB care Key Implications n National health systems should develop national policies that promote integral, patient-centered TB care, facilitate the implementation of ethical community interventions, support operational research, and allow the integration of appropriate eHealth applications. n Program managers who understand challenges in TB prevention and control with coexisting health priorities can serve as instrumental leaders and patient advocates to deliver high-quality and sustainable TB care that leads to achieving targets of the End TB Strategy.

Background: Health professionals should be prepared to lead and contribute to initiatives that mitigate emerging global health risks to target communities. Health professions education, however, has inconsistently incorporated essential global health topics into curricula despite growing interest among health professional students. Objective: To identify targeted strategies that health professions educators can integrate into coursework to strengthen global health training. Method: A narrative review of the literature was conducted to describe clinical and non-clinical skills that are indispensable to strong global health leadership. Results: Five strategies were highlighted that health professions educators can utilise to empower health professional students to strengthen their scientific knowledge base, develop ethical and culturally-appropriate community health interventions and effectively communicate health messages to stakeholders. Conclusion: Incorporating global health topics into health professions curricula can provide health professional students with a repertoire of evidence-based resources to apply in their clinical and community health initiatives. A trained global health workforce is essential to help nations achieve established national and international health objectives, such as the Sustainable Development Goals.

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