Facilitators and barriers to tuberculosis case notification among private health facilities in Kampala Capital City

Abstract

Introduction: The linkage of Private Health Providers (PHPs) is known to improve Tuberculosis (TB) case finding in the fight against the TB epidemic. In Uganda, 58% of people with TB related symptoms seek care initially from the private health sector, however, notification rates from this sector continue to remain comparatively low at 21%, and TB notification has not changed significantly despite efforts to link these PHPs. This study therefor set out to assess facilitators and barriers to TB case notification among private facilities in Kampala Capital City. Methods: A mixed methods study among private facilities in three (3) divisions of Kampala Capital City was conducted between March and July 2022. Data collection involved conducting a survey, IDIs and KIIs among private health workers at the selected facilities, the division TB focal persons and some TB program officers. We visited 238 private facilities where we administered questionnaires among 224 health workers. We also carried out in-depth interviews and Key informant interviews among 14 participants. Associations between various factors that act as barriers and facilitators to TB case notification we determined using Modified Poisson regression. Using ATLAS.ti software, generated themes on notification practices and facilitators and barriers to TB case notification. Results: Of the 224 health workers, majority 39.3%(88) were from facilities in Nakawa division, 55.4% (124) were male and the mean age was 32.6 years (SD=8.6). Among those who reported not to know how to screen for TB 48%(108), 39%(42) attributed it to having no guidelines and 18%(20) lacking diagnostic facilities. Some private health facilities (80%) did TB screening and diagnosis consistently, and they generally referred suspected TB cases/specimen to nearby public facilities for further diagnosis. The main facilitators of TB case notification were: support supervision, engagement activities, motivation and funding for community case finding activities. The main barriers included TB stigma, lack of TB training and facility TB Continuous Medical Education, and lack of diagnostic facilities while from the survey, prevalence of TB notification was significantly lower among facilities lacking TB guidelines and health workers trained in TB and in facilities in Kawempe and Nakawa. Conclusions: Private health facilities in Kampala Capital City are generally not opposed to programmatic TB case notification but need regular supervision and engagement activities to ensure that they have knowledge, equipment and some funding support to carry out TB case notification according to policy requirements.