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Following Guidelines for Drug-Resistant Tuberculosis: “Yes, it’s a challenge”

Gray, AT; Wood, CE; Boyles, T; Luedtke, S; Birjovanu, G; Hughes, J; Kostkova, P; (2021) Following Guidelines for Drug-Resistant Tuberculosis: “Yes, it’s a challenge”. Frontiers in Tropical Diseases , 2 , Article 645933. 10.3389/fitd.2021.645933. Green open access

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Abstract

BACKGROUND: Drug-resistant tuberculosis (DR-TB) is a major contributor to antimicrobial resistance (AMR) globally and is projected to be responsible for up to a quarter of AMR-associated deaths in the future. Management of DR-TB is increasingly decentralised to primary healthcare settings, and simultaneously becoming more complex due to a growing range of treatment options (e.g. novel agents, shorter regimens). This is reflected in the numerous recent updates to international guidelines and as such understanding the barriers and enablers to how healthcare workers access and use guidelines is vital. MATERIAL AND METHODS: We used an established psychological framework – the theoretical domains framework (TDF) – to construct and analyse an online survey and focus groups to explore healthcare workers current use of DR-TB guidelines in South Africa. We aimed to identify barriers and enablers with which to direct future attempts at improving guideline use. RESULTS: There were 19 responses to the online survey and 14 participants in two focus groups. 28% used the most up-to-date national guidelines, 79% accessed guidelines primarily on electronic devices. The TDF domains of ‘Social Influences’ (mean Likert score = 4.3) and ‘Beliefs about Consequences’ (4.2) were key enablers, with healthcare workers encouraged to use guidelines and also recognising the value in doing so. ‘Environmental Resources’ (3.7) and ‘Knowledge’ (3.3) were key barriers with limited, or variable access to guidelines and lack of confidence using them being notable issues. This was most noted for certain subgroups: children, HIV co-infected, pregnant women (2.7). DISCUSSION: Current use of DR-TB guidelines in South Africa is suboptimal. Planned interventions should focus on overcoming the identified key barriers and might include an increased use of digital tools.

Type: Article
Title: Following Guidelines for Drug-Resistant Tuberculosis: “Yes, it’s a challenge”
Open access status: An open access version is available from UCL Discovery
DOI: 10.3389/fitd.2021.645933
Publisher version: https://doi.org/10.3389/fitd.2021.645933
Language: English
Additional information: © 2021 Gray, Wood, Boyles, Luedtke, Birjovanu, Hughes, Kostkova and Esmail. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Keywords: Drug-resistant tuberculosis, decentralised, theoretical domains framework (TDF), guidelines, clinical decision support (CDS)
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
URI: https://discovery.ucl.ac.uk/id/eprint/10126359
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