Thesis:

Factors associated with tuberculosis preventive therapy prescription for contacts of bacteriologically confirmed tb patients in Bushenyi, southwestern Uganda

This research focused on establishing the factors associated with tuberculosis preventive therapy prescription for contacts of bacteriologically confirmed TB patients in Bushenyi district, south western Uganda. The study-specific objectives were: a) to establish proportion of eligible contacts of Pulmonary Bacteriologically Confirmed (PBC) TB patients who had been prescribed TPT in Bushenyi district, South Western Uganda, b) To find out the health system factors affecting TPT prescription for contacts of PBC TB patients in Bushenyi District, Southwestern Uganda. and c) to establish the knowledge, perceptions, and attitudes factors affecting TPT prescription for contacts of TB patients in Bushenyi District Southwestern Uganda. This was a cross-sectional study. A data abstraction tool was used to pick data for computing the proportions of TPT prescription. A self-administered, semi-structured questionnaire was employed to collect the research data on health system factors and knowledge perceptions and attitudes among health workers. The respondents were health care workers and health facility managers in all the seventeen TB diagnostic and treatment health facilities in Bushenyi districts. The proportions of eligible contacts of PBC TB patients who had been prescribed TPT in Bushenyi was 77.1%, way below the 90% target set by WHO and MOH-NTLP. Exploratory Factor Analysis was conducted to identify health system factors affecting TPT prescription for contacts of PBC TB patients. Six explanatory factors were revealed, and these are: latent TB testing, TPT service delivery, TPT financing, human resources for TPT, monitoring and evaluation for TPT, and health workers’ attitude towards TPT. In the bivariate logistic regression analysis, perception of patient as being uncomfortable with TPT (OR 4.42 95% CI:1.87-11.7; p=0.001), low healthcare worker’s knowledge of TB and TPT (OR 3.94 95% CI: 1.61-11.1; p=0.005), and negative healthcare worker’s attitude towards TPT prescription (OR 4.56 95% CI: 1.28-29.2; p = 0.045) were significantly associated with low TB prescription. However, in the multivariate logistic regression analysis, the perception of patient being uncomfortable with TPT (aOR 5.58 95% CI: 2.18-16.0; p = <0.001). and gaps in knowledge among healthcare worker about TB and TPT (aOR 5.97 95% CI: 2.08-19.6; p=0.002) were significantly associated with less likelihood of TPT prescription by a healthcare worker. In conclusion, this study found lower TPT prescription in the study area (77.1%) and identifies six key factors accounting for low TPT prescription. These are: Latent TB testing, TPT service delivery, TPT financing, human resources for TPT, Monitoring and evaluation for TPT, and healthcare workers' attitude towards TPT. Furthermore, it identified that knowledge gap on TB and TPT among healthcare workers, a perception that patients are uncomfortable with TPT and negative healthcare workers’ attitudes towards TPT prescription were significantly associated with low TB prescription. This study recommends close monitoring of the TPT program for contacts at all the TB DTUs, prioritizing the lower level health centers, improving the human and financial resources for TPT, undertaking TPT capacity-building activities including training and mentorship for health workers, and designing simple, easy-to-use TPT guidelines and job aids.