Programa de Pós-graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Universidade, Rio de Janeiro, Rua Macedo Sobrinho 74/203, Humaitá, Rio de Janeiro, 22271-080, Brazil.
Respiratory Epidemiology & Clinical Research Unit (RECRU), McGill University, Montreal, Canada.
BMC Health Serv Res. 2019 Jul 30;19(1):532. doi: 10.1186/s12913-019-4231-x.
Tuberculosis elimination requires treatment of latently infected high-risk persons, such as contacts of index cases. Identification and referral of tuberculosis contacts for investigation are major barriers in the contact cascade-of-care. These tasks rely heavily on auxiliary primary healthcare workers in many low- and middle-income countries. We aimed to understand their knowledge, attitudes and practices (KAP) regarding contact investigation in Brazil.
We conducted a cross-sectional KAP survey on tuberculosis transmission and prevention among 135 auxiliary healthcare workers in three tuberculosis high-burden Brazilian cities. Trained interviewers applied a translated version of a previously applied questionnaire. Open answers were classified in pre-defined objective categories and analysed quantitatively. Answers were further classified as satisfactory or not according to criteria set by a panel of three specialists.
Although 66% had received tuberculosis training in the past 10 years, only 19% were trained for tuberculosis prevention. 64% could not clearly distinguish latent tuberculosis infection (LTBI) from active tuberculosis; 63% did not know how to diagnose LTBI and 52% did not know how to prevent progression to active tuberculosis. Most believed that it is important to investigate adult (99%) and child (96%) contacts for LTBI. However, not all invite contacts - children (81%) or adults (71%) - to the clinic, despite only 24% perceiving difficulties for investigation.
Gaps in KAP among auxiliary health workers have been reported in other areas, such as obstetrics and other infectious diseases. To the best of our knowledge, this is the first KAP survey on tuberculosis transmission and prevention among auxiliary health care workers, and relevant gaps were also found. Knowledge gaps were notably related to LTBI management, including how to recognize it and prevent progression to active tuberculosis through treatment, despite most recognizing the importance of investigating contacts. Auxiliary healthcare workers in three Brazilian high-burden cities have important knowledge gaps despite their perception of the importance of tuberculosis prevention among contacts. They need to incorporate contact referral as one of their tasks to enable progress toward the target of tuberculosis elimination.
结核病消除需要对潜伏性感染高危人群（如确诊病例的接触者）进行治疗。在接触者关怀链中，发现和转介结核病接触者进行调查是主要障碍。在许多中低收入国家，这些任务主要依赖于辅助初级卫生保健工作者。我们旨在了解巴西辅助卫生保健工作者在接触者调查方面的知识、态度和实践（KAP）。
我们在巴西三个结核病高负担城市的 135 名辅助卫生保健工作者中进行了结核病传播和预防的横断面 KAP 调查。经过培训的访谈者应用了先前应用的问卷的翻译版本。开放式答案被归类为预先定义的客观类别，并进行定量分析。根据专家组设定的标准，进一步将答案分为满意或不满意。
尽管 66%的人在过去 10 年中接受过结核病培训，但只有 19%的人接受过结核病预防培训。64%的人无法清楚区分潜伏性结核病感染（LTBI）和活动性结核病；63%的人不知道如何诊断 LTBI，52%的人不知道如何预防活动性结核病进展。大多数人认为调查成人（99%）和儿童（96%）接触者的 LTBI 很重要。然而，并非所有接触者——儿童（81%）或成人（71%）——都被邀请到诊所，尽管只有 24%的人认为调查有困难。
在其他领域，如产科和其他传染病，已经报道了辅助卫生工作者在 KAP 方面的差距。据我们所知，这是首次对辅助卫生保健工作者的结核病传播和预防进行 KAP 调查，也发现了相关差距。知识差距主要与 LTBI 管理有关，包括如何识别它以及通过治疗预防活动性结核病，尽管大多数人认识到调查接触者的重要性。尽管巴西三个高负担城市的辅助卫生保健工作者认识到接触者预防结核病的重要性，但他们仍存在重要的知识差距。他们需要将接触者转介作为他们的任务之一，以实现结核病消除目标。
