Health system influences on the implementation of tuberculosis infection prevention and control at health facilities in low-income and middle-income countries

A scoping review

Bibliographic Data

ID21879566
AuthorsGimenne Zwama (0000-0001-9458-522X, Queen Margaret University, corresponding author), Karin Diaconu (0000-0002-5810-9725, Queen Margaret University), Anna Silvia Voce (0000-0001-9082-4449, University of KwaZulu-Natal), Fiona O’May (0000-0003-4417-2819, Queen Margaret University), Anne D Grant (0000-0002-2437-5195, University of the Witwatersrand), Karina Kielmann (0000-0001-5519-1658, Queen Margaret University)
Year2021
Volume6
Issue5
Pagese004735
Publication date2021-05-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2020-004735
PMID33975887
OpenAlexW3163304012
LanguageEN
Citations received10
References cited85

BACKGROUND: Tuberculosis infection prevention and control (TB-IPC) measures are consistently reported to be poorly implemented globally. TB-IPC guidelines provide limited recognition of the complexities of implementing TB-IPC within routine health systems, particularly those facing substantive resource constraints. This scoping review maps documented system influences on TB-IPC implementation in health facilities of low/middle-income countries (LMICs). METHODS: We conducted a systematic search of empirical research published before July 2018 and included studies reporting TB-IPC implementation at health facility level in LMICs. Bibliometric data and narratives describing health system influences on TB-IPC implementation were extracted following established methodological frameworks for conducting scoping reviews. A best-fit framework synthesis was applied in which extracted data were deductively coded against an existing health policy and systems research framework, distinguishing between social and political context, policy decisions, and system hardware (eg, information systems, human resources, service infrastructure) and software (ideas and interests, relationships and power, values and norms). RESULTS: Of 1156 unique search results, we retained 77 studies; two-thirds were conducted in sub-Saharan Africa, with more than half located in South Africa. Notable sociopolitical and policy influences impacting on TB-IPC implementation include stigma against TB and the availability of facility-specific TB-IPC policies, respectively. Hardware influences on TB-IPC implementation referred to availability, knowledge and educational development of staff, timeliness of service delivery, availability of equipment, such as respirators and masks, space for patient separation, funding, and TB-IPC information, education and communication materials and tools. Commonly reported health system software influences were workplace values and established practices, staff agency, TB risk perceptions and fears as well as staff attitudes towards TB-IPC. CONCLUSION: TB-IPC is critically dependent on health system factors. This review identified the health system factors and health system research gaps that can be considered in a whole system approach to strengthen TB-IPC practices at facility levels in LMICs

Business · Developing country · Economic growth · Economics · Environmental health · Infection control · Low and middle income countries · Low income · Pathology · Public health · Socioeconomics · Tuberculosis · Tuberculosis control · Tuberculosis prevention · Antibiotic Use and Resistance · Healthcare Facilities Design and Sustainability · Medicine · Nursing · Tuberculosis Research and Epidemiology · Surgery

Tools

Open DOIOpen Access