Exploration of barriers and facilitators to household contact tracing of index tuberculosis cases in Anlemo district, Hadiya zone, Southern Ethiopia: Qualitative study

Abstract

Background Tuberculosis [TB] is the second leading cause of death from an infectious disease in the world. Intensifying tuberculosis screening and contact investigation strategy is recommended to ensure early diagnosis among household contacts of TB patients. Studies showed that there is low TB contact tracing. There was limited evidence on barriers and facilitators of household contact tracing. Therefore, this study was aimed at exploring barriers and facilitators for household contact tracing of index TB cases. Methods A descriptive qualitative study was conducted at Anlemo district, Hadiya zone, Ethiopia from March 12-April 9, 2019. Purposive sampling technique was used to recruit study participants. A total of 16 participants were involved in the study which included health extension workers [HEWs], index TB patients, household contacts of TB patients, health center TB focal and district TB coordinator. Data were collected through in-depth interviews using a semi-structured guide, transcribed verbatim and translated into English. Inductive thematic analysis was employed using ATLAS.ti7.1 software and the findings were presented on major themes, categories, and quotations. Results This study found low TB contact tracing and investigation, and explored barriers and facilitators such as monitoring and supervision, training of health workers, logistics and infrastructure, waiting time and institutional readiness, referral, feedback and linkage, human resource, charge for some laboratory, transportation, budget, knowledge, commitment and motivation, workload, distance, social support, economic constrain, and stigma and discrimination for household contact tracing of index TB cases under four themes.

Capitalizing on facilitators and addressing barriers when implementing active tuberculosis case-finding in six districts of Ho Chi Minh City, Vietnam: a qualitative study with key stakeholders

“…While many studies examining facilitators and barriers for ACF implementation focus on descriptions of what these factors are, our study also provided examples and ideas of how to address them. To name a few examples of how our results are aligned with the literature, our results show that employees and volunteers’ experience, skills, and motivation influence ACF implementation, which other studies have also described [ 20 – 22 , 31 , 32 ]. For instance, a qualitative study conducted in Kampala, Uganda, described the provision of personalized care and enabling TB patients support as a key facilitator for TB contact investigation [ 20 ].…”

Implementation of a volunteer contact tracing program for COVID-19 in the United States: A qualitative focus group study

“…These factors can make it difficult to establish and maintain a stable workforce. Payment or other forms of reward have been shown to increase motivation and commitment of tracers in other settings [31,35,38,51], and our participants echoed the importance of feeling valued and appreciated for their efforts. We recommend that programs unable to hire employees for contact tracing consider providing academic credit or certificates to volunteers to acknowledge their critical contributions to pandemic response.…”

“…A shortage of human resources is a major challenge to adoption of contact tracing for COVID-19 and other communicable diseases [31,33,[38][39][40][41], both because many contact tracers are needed and because this capacity must be flexible enough to expand and contract with the waves and surges of the epidemic. In addition, as noted above, outreach workers must have good communication skills and a detailed knowledge of program policies and guidelines [35,38,42,43]. Engaging/hiring volunteers is one option for rapidly scaling a pandemic contact tracing workforce [44] and was a strength identified by our study participants.…”

“…These implementation factors may also have positive spillover effects for adoption, reach, and effectiveness in that efficient, user-friendly, non-redundant systems benefit call recipients and contact tracers alike. Two simple suggestions for improving efficiency included adopting more accessible tools for data collection and management, as shown with contact tracing for other diseases [ 33 , 38 , 39 , 41 , 47 ], and coordinating case and contact interviews within the same household as is commonly done in tuberculosis contact investigation [ 48 , 49 ]. A threat that participants identified, poor inter-agency communication, has also been described during tuberculosis contact investigation in border regions [ 39 ].…”

Perception and Experience of Health Extension Workers on Facilitators and Barriers to Maternal and Newborn Health Service Utilization in Ethiopia: A Qualitative Study

“…The trustworthiness of this study was ensured through credibility, dependability, transferability, and conformability principles [ 17 , 19 , 20 , 21 , 22 , 23 , 24 ]. The credibility of the study was ensured through peer debriefing, triangulation, and member checking.…”