Health Worker Practices, Facilitators and Barriers towards the Intensified Case-Finding Tuberculosis Screening Tool in Uganda

IntroductionAlthough the Tuberculosis (TB) Intensified Case Finding (ICF) tool was introduced in 2011, only 15.7% of the estimated 35 million people living with HIV were screened for TB in 2013. We explored the facilitators, barriers and health care workers practices regarding use of the ICF tool in TB screening. MethodsWe conducted a qualitative study in Jinja, eastern Uganda. We purposively sampled eight (4 private and 4 Government) health facilities (HFs) with the guidance of the District TB and Leprosy Supervisor (DTLS). At each health facility, three health care workers (in-charge TB clinic, a TB focal person & one laboratory technician (total: 24 participants in 8 HFs) were interviewed using a key informant interview guide. Data were collected on how TB was screened and diagnosed in general and when using the ICF tool in particular. Data were audio-recorded, transcribed in verbatim, coded and analyzed using a thematic framework. ResultsThe ICF tool was available in all the 8 HFs; however, only half (12/24) the health workers interviewed at these facilities had ever used it for screening TB. The facilitators to ICF use were all levels of health cadres could use it, with simple, close-ended questions and clear, simple instructions. However, several barriers were identified as hindering the use of the ICF tool. The barriers to the use of the ICF tool are segmented according to the Health System building blocks, Leadership and Governance Barriers (concurrent use of other tools, lack of detailed training), Health Workforce Barriers (Lack of awareness of about the tool, perceived increased workload) and Health Information Management System Barriers (Stock-outs of the ICF tools). DiscussionThe ICF tool was found to be simple and easy to use; however, its use remained low due to a variety of perceived barriers by health workers. There is a need to increase the health care workers awareness about the ICF tool to improve its utilization in TB screening.