Primary care providers’ and nurses’ knowledge, attitudes, and skills regarding latent TB infection testing and treatment: A qualitative study from Rhode Island

Szkwarko, Daria; Kim, Steven; Carter, E. Jane; Goldman, Roberta E.

doi:10.1371/journal.pone.0267029

Cited by 8 publications

(13 citation statements)

References 11 publications

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“…A recent qualitative study regarding PCPs' knowledge and attitudes regarding LTBI care in RI confirmed that PCPs' lack confidence with all steps of the LTBI care cascade and this confidence decreases with later steps-particularly treatment initiation and completion. 21 Further formal qualitative work is needed at our clinic to confirm these findings and identify strategies to improve PCPs' knowledge and confidence. Educational efforts such as the Regional Latent TB Infection ECHO (Extension for Community Healthcare Outcomes) 22 is one existing strategy that could potentially improve LTBI management by PCPs within primary care facilities.…”

Section: Discussionmentioning

confidence: 96%

“…Let’s consider the gaps in TB knowledge, attitude, and skills. 21 Diseases such as TB that disproportionately impact racial and ethnic minorities are often taught in a manner that does not include how racial social inequity influences pathology. Additionally, historical and sociopolitical factors that worsen health outcomes among patients are often missing in medical curricula.…”

Section: Discussionmentioning

confidence: 99%

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Latent Tuberculosis Infection Treatment Outcomes in an At-Risk Underserved Population in Rhode Island

Verma

Pacheco

Carter

et al. 2022

J Prim Care Community Health

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Objectives: Within the United States (US), significant racial and ethnic disparities exist in the rates of latent TB infection (LTBI) and active TB disease. A disproportionate number of TB disease cases result from untreated LTBI among individuals born outside the US. This study evaluates LTBI treatment outcomes among an underserved, at-risk population in Rhode Island. Methods: A quantitative retrospective chart review of adult patients with a positive screening test assessed LTBI care cascade outcomes including referral, treatment initiation, and completion. Results: Seventy-four percent of patients found to have positive screening TB tests were born outside of the US; 80% identified as Hispanic or Black and 45% spoke a preferred language other than English. Twenty-one percent of potential candidates for LTBI treatment initiated treatment. Conclusions: Major gaps were identified in referral success and treatment initiation. Expanding LTBI treatment access into primary care settings could be a solution to improve outcomes and decrease health inequities among at-risk communities.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Latent Tuberculosis Infection Treatment Outcomes in an At-Risk Underserved Population in Rhode Island

Verma

Pacheco

Carter

et al. 2022

J Prim Care Community Health

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“…Eight studies were from lower-middle-income countries [ 9 , 31 , 36 , 37 , 40 , 41 , 43 , 46 ], five were from upper-middle-income countries [ 6 , 33 , 34 , 39 , 45 ], six were from high-income countries [ 7 , 8 , 32 , 38 , 47 , 48 ] and two were from low-income countries [ 35 , 42 ]. Four studies had representatives from a mix of countries with different income levels [ 5 , 29 , 30 , 44 ].…”

Section: Resultsmentioning

confidence: 99%

A synthesis of qualitative evidence of barriers and facilitators in implementing guidelines for TB testing in healthcare settings

Karanja,

Mulaku,

Ochodo

2024

Implement Sci Commun

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Introduction The suboptimal case notification rates for tuberculosis (TB) globally could partly be due to the poor implementation of TB testing guidelines or policies. We identified, appraised and synthesized qualitative evidence exploring the barriers and facilitators to implementing TB testing guidelines. Methods We searched electronic databases and grey literature and included studies based on predefined inclusion criteria (PROSPERO registered protocol CRD42016039790) until 9th February 2023. We used the Critical Appraisal Skills Programme tool to assess the methodological quality of the included studies. Two authors reviewed the search output, extracted data and assessed methodological quality independently, resolving disagreements by consensus. We used the Supporting the Use of Research Evidence framework to identify themes and analyse and synthesize our data. We applied the Confidence in the Evidence from Reviews of Qualitative Research approach to assess the confidence of the review findings. Results Our search output was 6976 articles, from which we included 25 qualitative studies, mostly from low- and middle-income countries (n=19) and about national guidelines (n=22). All studies were from healthcare settings. Most barriers revolved around health system constraints involving the guidelines (low trust and adherence, ambiguous and poorly developed or adapted guidelines) and poorly resourced and organized health facilities to enable the implementation of the guidelines. Individual-level barriers included low trust and low awareness among recipients and providers of care. Donor dependence was the main socio-political constraint. These barriers were similar across all income settings except poorly resourced health facilities and social and political constraints which were only reported in low- and middle-income settings. The reported facilitators were improved trust and knowledge of guidelines, national leadership support and availability of training tools and opportunities for guidelines across all income settings. We had high confidence in most of the review findings. Conclusion Limited guideline knowledge, trust and adherence related to poorly developed and disseminated guidelines in all income settings and poorly resourced facilities in low- and middle-income countries hinder the implementation of TB testing guidelines. This could be improved by better guideline training and adaptation and resourcing of health facilities. Trial registration The protocol of this review was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42016039790, and published in a peer-reviewed journal.

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“…Some studies suggest they are not. 19,20 The needs and optimal strategies to integrate LTBI care into primary care have not been well studied. More than 50 years after LTBI screening and treatment were first widely recommended and implemented, 21 there is still remarkably little evidence about implementing LTBI diagnosis and treatment in primary care in North America.…”

mentioning

confidence: 99%

“…Are primary care practitioners ready? Some studies suggest they are not . The needs and optimal strategies to integrate LTBI care into primary care have not been well studied.…”

mentioning

confidence: 99%

Screening for Latent Tuberculosis Infection

Menzies

2023

JAMA Netw Open

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The US Preventive Services Task Force (USPSTF) has recommended screening of adults at increased risk for latent tuberculosis (TB) infection (LTBI). 1 This recommendation (B statement) is based on an evidence review 2 that found that available tests-in particular, the tuberculin skin test and interferon-γ release assays-were sufficiently accurate to identify persons with LTBI and that TB preventive treatment (TPT) regimens now recommended in the US 3 should provide moderate net benefit 1 to persons identified from screening. The USPSTF advised following the recommendations for testing in persons who have immunosuppression made by the American Thoracic Society and Centers for Disease Control and Prevention 2017 4 and recommendations for TPT made by the Centers for Disease Control and Prevention in 2020. 3 The USPSTF noted that this recommendation is for adults not included in other recommendations 3,4 for LTBI testing and treatment, such as persons living with HIV, persons about to receive a solid-organ transplantation or tumor necrosis factor-α inhibitors, or other groups at increased risk because of immune suppression. The task force also noted that this recommendation is not for contacts of persons with a recent diagnosis of active TB disease, who are generally investigated by public health services. Hence, these recommendations are focused on persons who are otherwise healthy but have increased likelihood (risk) of having TB infection. Although this includes some US-born persons, the vast majority of persons who will be affected by this recommendation are individuals who immigrated to the US from countries where TB incidence is much higher. On the basis of estimates of the prevalence of LTBI among persons in the US who were born outside the US, 5 this represents a very substantial increase from the number of persons now screened.Before starting screening, a reminder is needed. The USPSTF also recommends that to achieve the benefit of screening, it is important that persons who screen positive for LTBI receive follow-up and treatment 1 ; if TPT is not completed, then there will be no benefit of screening. Hence, a decision to implement screening for LTBI in any setting or for any population must include a commitment to ensure adequate follow-up of those with positive test results. 6 This includes medical and radiographic evaluation to exclude TB disease, offering TPT to all those who are eligible, and then education and counseling plus subsequent close follow-up of those who accept TPT, to ensure adherence as well as to detect and manage any adverse effects. Substantial time and resources are needed to ensure that care is well organized for all steps in the cascade to minimize losses, or a screening program will have far less benefit than expected. 6 Numerous studies have shown that there are substantial losses in the cascade of LTBI care, at the steps of initial identification of candidates for screening (testing), medical evaluation, and offering TPT, as well as acceptance and completion of TPT by individuals,...

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Primary care providers’ and nurses’ knowledge, attitudes, and skills regarding latent TB infection testing and treatment: A qualitative study from Rhode Island

Cited by 8 publications

References 11 publications

Latent Tuberculosis Infection Treatment Outcomes in an At-Risk Underserved Population in Rhode Island

Latent Tuberculosis Infection Treatment Outcomes in an At-Risk Underserved Population in Rhode Island

A synthesis of qualitative evidence of barriers and facilitators in implementing guidelines for TB testing in healthcare settings

Screening for Latent Tuberculosis Infection

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