Factors associated with healthcare workers’ adherence to national guidelines for MDR TB surveillance in Uganda: A case study of the West Nile region

Abstract

Background: A previous history of tuberculosis (TB) treatment has been identified as a risk factor for multidrug resistant TB. Therefore these patients are a high priority group for whom culture and drug-susceptibility testing (DST), the gold standard for diagnosing MDR-TB, should be performed in 100% of cases. However in 2010, only 9% of retreatment cases in Uganda received DST despite national guidelines and programmatic support for this practice. In the West Nile Region, only 19% of all retreatment cases received DST during the same year.

Objectives: To investigate the factors associated with the level of healthcare workers’ adherence to the Uganda National Guidelines for MDR TB Surveillance in selected health facilities in the West Nile Region.

Methodology: A cross-sectional study design was used. To assess the effect of healthcare worker characteristics and support supervision on adherence to MDR TB Surveillance guidelines, face to face interviews were conducted using structured questionnaires among healthcare workers in health facilities participating in MDR-TB surveillance Health facility checklists were used to examine the effect of the presence of tools and supplies on the level of adherence. Document reviews of NTLP laboratory registers, NTLP TB Unit Registers and copies of sputum transportation forms were done to verify proportion of sputum samples from patients at “high risk” of developing MDR TB that were sent for DST. Key informant interviews were conducted with the District TB Focal Persons, District Laboratory Focal Persons and Health Sub district TB Focal Persons to gain insight into other factors associated with healthcare workers’ adherence to National Guidelines for MDR TB Surveillance. Results: Out of the 198 healthcare workers interviewed, only 29% had received additional training on MDR TB. However knowledge scores were higher, with 47.5% of all healthcare workers having scores of 80% or more. The proportion of healthcare workers at a health facility with a knowledge score of 80% was highly correlated with adherence to MDR TB surveillance guidelines (ρ = 0.66, p value <0.05). When the healthcare worker characteristics were assessed in aggregate, a higher composite score of healthcare workers’ characteristics was highly correlated to a health facilities’ adherence to the guidelines (ρ = 0.65, p value 0.001). Supportive supervision, if received at least once every three months was significantly associated with improved adherence to the guidelines (p value 0.02), while the presence of all tools and supplies necessary for MDR TB surveillance was marginally associated with improved adherence (p value 0.05). Conclusion: The proportion of healthcare workers with a knowledge score of 80%, and regular supportive supervision were associated with improved levels of adherence to MDR TB Surveillance guidelines. Although only marginally significant, the presence of all equipment and tools necessary for MDR TB surveillance was also associated with improved adherence to the guidelines.