Context matters: Examining the factors impacting the implementation of tuberculosis infection prevention and control guidelines in health settings in seven high tuberculosis burden countries

Islam, Md. Saiful; Chughtai, Abrar Ahmad; Seale, Holly

doi:10.1016/j.jiph.2021.01.014

Cited by 15 publications

(10 citation statements)

References 31 publications

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“…Unit costs for core intervention activities and enablers were estimated using price and quantity data from the published literature and quotes from local suppliers. Unit costs captured the incremental economic costs of all core activities, including the opportunity cost of staff time, recognizing that even activities that are not time-consuming and that are already implemented to some degree, such as opening windows and doors to improve ventilation or directing queuing patients, will need dedicated staff to increase their feasibility and impact compared to current levels ( Islam et al. , 2021 ).…”

Section: Methodsmentioning

confidence: 99%

Using system dynamics modelling to estimate the costs of relaxing health system constraints: a case study of tuberculosis prevention and control interventions in South Africa

Bozzani

Diaconu

Gomez

et al. 2021

Health Policy and Planning

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Health system constraints are increasingly recognised as an important addition to model-based analyses of disease control interventions, as they affect achievable impact and scale. Enabling activities implemented alongside interventions to relax constraints and reach the intended coverage may incur additional costs, which should be considered in priority setting decisions. We explore the use of group model building, a participatory system dynamics modelling technique, for eliciting information from key stakeholders on the constraints that apply to tuberculosis infection prevention and control processes within primary healthcare clinics in South Africa. This information was used to design feasible interventions, including the necessary enablers to relax existing constraints. Intervention and enabler costs were then calculated at two clinics in KwaZulu-Natal using input prices and quantities from the published literature and local suppliers. Among the proposed interventions, the most inexpensive were retrofitting buildings to improve ventilation (US$ 1,644 per year), followed by maximising the use of community sites for medication collection among stable patients on antiretroviral therapy (US$ 3,753) and introducing appointments systems to reduce crowding (US$ 9,302). Enablers identified included enhanced staff training, supervision and patient engagement activities to support behaviour change and local ownership. Several of the enablers identified by the stakeholders, such as obtaining building permissions or improving information flows between levels of the health systems, were not amenable to costing. Despite this limitation, an approach to costing rooted in system dynamics modelling can be successfully applied in economic evaluations to more accurately estimate the ‘real world’ opportunity cost of intervention options. Further empirical research applying this approach to different intervention types (e.g. new preventive technologies or diagnostics) may identify interventions that are not cost-effective in specific contexts based on the size of the required investment in enablers.

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Section: Methodsmentioning

confidence: 99%

Using system dynamics modelling to estimate the costs of relaxing health system constraints: a case study of tuberculosis prevention and control interventions in South Africa

Bozzani

Diaconu

Gomez

et al. 2021

Health Policy and Planning

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“…However, TB patient management, HCWs exposures and practices identified in these facilities are like chest diseases hospitals, other public and private facilities, and clinics in Bangladesh [1,2,42]. The findings from this study can be a strong indicator of what is happening in similar hospitals in Bangladesh and other low-income settings [42,43]. Second, each field team members were responsible for observing 8-10 patients and their caregivers.…”

Section: Discussionmentioning

confidence: 80%

“…When this study was conducted, there were no or limited studies about PTB patient management and healthcare workers' (HCWs) exposures to untreated TB patients in public tertiary care general hospitals, Bangladesh. Due to the lack of evidence about PTB patients' stay in Bangladesh's public tertiary care general hospitals, the implementation of TB IPC measures in these facilities remained challenging [11,12]. This study aimed to assess PTB patients' length of hospital stay and management and healthcare workers' exposures to PTB patients, and the use of PPE in two public tertiary care hospitals in Bangladesh.…”

Section: Introductionmentioning

confidence: 99%

Examining pulmonary TB patient management and healthcare workers exposures in two public tertiary care hospitals, Bangladesh

Islam

Chowdhury

Nazneen

et al. 2022

PLOS Glob Public Health

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Implementation of tuberculosis (TB) infection prevention and control (IPC) guidelines in public tertiary care general hospitals remain challenging due to limited evidence of pulmonary TB (PTB) patients’ duration of hospital stay and management. To fill this evidence gap, this study examined adult PTB patient management, healthcare workers’ (HCWs) exposures and IPC practices in two public tertiary care hospitals in Bangladesh.Between December 2017 and September 2019, a multidisciplinary team conducted structured observations, a hospital record review, and in-depth interviews with hospital staff from four adult medicine wards.Over 20 months, we identified 1,200 presumptive TB patients through the hospital record review, of whom 263 were confirmed PTB patients who stayed in the hospital, a median of 4.7 days without TB treatment and possibly contaminated the inpatients wards. Over 141 observation hours, we found a median of 3.35 occupants present per 10 m2 of floor space and recorded a total of 17,085 coughs and 316 sneezes: a median of 3.9 coughs or sneezes per 10 m2 per hour per ward. Only 8.4% of coughs and 21% of sneezes were covered by cloths, paper, tissues, or by hand. The HCWs reportedly could not isolate the TB patients due to limited resources and space and could not provide them with a mask. Further, patients and HCWs did not wear any respirators.The study identified that most TB patients stayed in the hospitals untreated for some duration of time. These PTB patients frequently coughed and sneezed without any facial protection that potentially contaminated the ward environment and put everyone, including the HCWs, at risk of TB infection. Interventions that target TB patients screening on admission, isolation of presumptive TB patients, respiratory hygiene, and HCWs’ use of personal protective equipment need to be enhanced and evaluated for acceptability, practicality and scale-up.

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“…In low-and middle-income countries (LMIC), TB IPC is considered a critical strategy for TB prevention and control in health settings [ 6 ]. International TB IPC guidelines that target health settings can be traced back to the 1980s, and the most recent TB IPC guidelines was updated and published in 2019 by the WHO [ 7 , 8 ]. As part of the WHO’s TB control strategy, many LMIC have developed national TB IPC guidelines; however, the implementation of these guidelines remains inconsistent due to multifaced factors prevailing in diverse health settings [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…International TB IPC guidelines that target health settings can be traced back to the 1980s, and the most recent TB IPC guidelines was updated and published in 2019 by the WHO [ 7 , 8 ]. As part of the WHO’s TB control strategy, many LMIC have developed national TB IPC guidelines; however, the implementation of these guidelines remains inconsistent due to multifaced factors prevailing in diverse health settings [ 8 ]. Bangladesh developed its national TB IPC guidelines in 2011, which includes a three-level hierarchy of control measures: administrative, environmental, and personal respiratory protection [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Preparedness of tertiary care hospitals to implement the national TB infection prevention and control guidelines in Bangladesh: A qualitative exploration

et al. 2022

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In high tuberculosis (TB) burden countries, health settings, including non-designated TB hospitals, host many patients with pulmonary TB. Bangladesh’s National TB Control Program aims to strengthen TB infection prevention and control (IPC) in health settings. However, there has been no published literature to date that assessed the preparedness of hospitals to comply with the recommendations. To address this gap, our study examined healthcare workers knowledge and attitudes towards TB IPC guidelines and their perceptions regarding the hospitals’ preparedness in Bangladesh. Between January to December 2019, we conducted 16 key-informant interviews and four focus group discussions with healthcare workers from two public tertiary care hospitals. In addition, we undertook a review of 13 documents [i.e., hospital policy, annual report, staff list, published manuscript]. Our findings showed that healthcare workers acknowledged the TB risk and were willing to implement the TB IPC measures but identified key barriers impacting implementation. Gaps were identified in: policy (no TB policy or guidelines in the hospital), health systems (healthcare workers were unaware of the guidelines, lack of TB IPC program, training and education, absence of healthcare-associated TB infection surveillance, low priority of TB IPC, no TB IPC monitoring and feedback, high patient load and bed occupancy, and limited supply of IPC resources) and behavioural factors (risk perception, compliance, and self and social stigma). The additional service-level gap was the lack of electronic medical record systems. These findings highlighted that while there is a demand amongst healthcare workers to implement TB IPC measures, the public tertiary care hospitals have got key issues to address. Therefore, the National TB Control Program may consider these gaps, provide TB IPC guidelines to these hospitals, assist them in developing hospital-level IPC manual, provide training, and coordinate with the ministry of health to allocate separate budget, staffing, and IPC resources to implement the control measures successfully.

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Context matters: Examining the factors impacting the implementation of tuberculosis infection prevention and control guidelines in health settings in seven high tuberculosis burden countries

Cited by 15 publications

References 31 publications

Using system dynamics modelling to estimate the costs of relaxing health system constraints: a case study of tuberculosis prevention and control interventions in South Africa

Using system dynamics modelling to estimate the costs of relaxing health system constraints: a case study of tuberculosis prevention and control interventions in South Africa

Examining pulmonary TB patient management and healthcare workers exposures in two public tertiary care hospitals, Bangladesh

Preparedness of tertiary care hospitals to implement the national TB infection prevention and control guidelines in Bangladesh: A qualitative exploration

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