Healthcare worker perceived barriers and facilitators to implementing a tuberculosis preventive treatment (TPT) program in Dhaka BRAC TB centers

Abstract

Introduction: Tuberculosis preventive Treatment (TPT) is a crucial step that will prevent the further development of latent tuberculosis infection (LTBI) into active tuberculosis. Yet, it faces numerous constraints when implemented in resource-limited urban environments, e.g., Dhaka, Bangladesh. This research analyzes the barriers and facilitators of TPT uptake at BRAC urban TB centers and provides direction for enhancing program delivery. Methods: Using an explanatory sequential mixed-methods design, qualitative and quantitative data were collected. In the above procedures, interviews with 17 healthcare providers were also conducted, and 41 Field Organizers (FOs) were polled through a survey. The qualitative data were coded thematically, and quantitative data were summarized using descriptive statistics. The Consolidated Framework for Implementation Research (CFIR) was applied to describe the study's outcome. Results: Barriers included resource constraints, such as drug shortages, funding gaps, and insufficient human resources. Logistical difficulties, stigmatization, lack of patient information, and inefficiencies in data capture also hampered the provision of TPT. Patient adherence was influenced by beliefs, pill size, side effects, and competing demands, including daily earnings. Factors included a willingness to use BRAC health care providers, adaptable TPT guidelines (e.g., 3HP regimen), suitable staffing, and working in partnership with the National Tuberculosis Program (NTP). Community support and engagement also emerged as critical enablers. Conclusion: Results underscore the need to take action on funding, staffing, and supply chains to enhance TPT delivery. Improvements to community education, private-sector collaboration, and streamlined documentation and monitoring practices can improve adherence and coverage. These recommendations offer a pathway to enhance TPT programs in settings with limited resources and help set targets to achieve the ambitious goal of TB elimination globally.