TB tracer teams in South Africa: knowledge, practices and challenges of tracing TB patients to improve adherence

Abstract

BackgroundIn 2008–2009 the South African National Tuberculosis (TB) Program (NTP) implemented a national pilot project, the TB Tracer Project, aiming to decrease default rates and improve patient outcomes. The current study aimed to inform the NTP by describing the knowledge, attitudes, and practices of TB program personnel involved with tracing activities.MethodsA self-administered written questionnaire was sent to TB staff, managers and tracer team leaders to assess basic TB knowledge, attitudes and practices. Descriptive statistics were used to summarize results and the chi-squared statistic was used to compare responses of staff at facilities that participated in the TB Tracer Project (tracer) and those that followed standard NTP care (non-tracer).ResultsOf 560 total questionnaires distributed, 270 were completed and returned (response rate 48%). Total TB knowledge ranged from 70.8-86.3% correct across all response groups. However, just over half (range 50–59.3%) of each respondent group was able to correctly identify the four components of a DOT encounter. A patient no longer feeling sick was cited by 72.1% of respondents as the reason patients fail to adhere to treatment. Tracer teams were viewed as an effective means to get patients to return to treatment by 96.3% of health facility level respondents. Tracer team leaders reported concerns including lack of logistical support (41.7%), insufficient physical safety precautions (41.7%), and inadequate protection from contracting TB (39.1%). Upon patients returning to treatment at the clinic, facilities included in the TB Tracer Project were significantly more likely to discuss alternate DOTS arrangements than non-tracer facilities (79.2 vs. 66.4%, p = 0.03).ConclusionsThis study identified key components of knowledge, attitudes, and practices regarding TB patient tracing activities in South Africa. Educating patients on the essential need to complete treatment irrespective of clinical symptoms may help improve treatment adherence. Future scale-up and integration of TB tracing activities as part of standard TB management should include provisions for standardized training of personnel on the critical elements of DOTS, and for ensuring appropriate supervision, logistical support, and physical safety and TB transmission protection of tracing teams.

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

“…Lack of regular monitoring and supervision has given to health centers and health posts were found as a barrier to contact tracing of index TB cases in the current study. This study finding agrees with a study conducted in South Africa that showed a lack of adequate supervision and direction from the district or provincial TB managers [20]. The World Health Organization also recommends conducting routine monitoring using standardized methods based on data with documented quality [5].…”

“They come and knock at the gate until the neighbours see”. Perceived barriers and benefits of implementing HIV care at the community level in Tshwane district: A qualitative study

“…The fact that some community health workers report having no masks to protect themselves from TB is therefore very concerning. Similar concerns were raised in a study [17] in which 39.1% (n = 270) of community health workers complained about inadequate protection from contracting TB. These fears are not unfounded: In a South African decade-long cohort study, health workers were reported to have a TB incidence of 1,496�32 per 100,000 compared to an incidence rate of 719�37 per 100,000 in the general population [18].…”

Exploring the promise and reality of ward-based primary healthcare outreach teams conducting TB household contact tracing in three districts of South Africa

“…Although studies report a high risk of TB infection and disease among health care workers in South Africa [17], outreach teams have insufficient training on TB infection prevention and control measures, limited resources for the maintenance of hygiene and short supply of personal protective equipment [18]. Essential training for outreach teams could include a standardised program with specific emphasis on TB household contact tracing, physical safety when conducting tracing activities such as being provided with personal protective equipment [19] current updates in the field of TB [9,[20][21][22] and field-based training on TB household contact tracing [23]. An approach that includes directed, structured training on contact tracing activities would also be beneficial to the ongoing COVID-19 response.…”