Pradipta Ivan S, Idrus Lusiana R, Probandari Ari, Puspitasari Irma Melyani, Santoso Prayudi, Alffenaar Jan-Willem C, Hak Eelko
Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia.
Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia.
Front Pharmacol. 2022 Mar 25;13:857783. doi: 10.3389/fphar.2022.857783. eCollection 2022.
Community health centers (CHCs) are a backbone healthcare facility for tuberculosis (TB) services. Identifying barriers amongst TB service providers at the CHC level is required to help them deliver successful TB treatment. : The current study aimed to analyze barriers to successful TB treatment from the perspective of TB service providers at the CHC level in a high prevalent TB country. A qualitative study was conducted using in-depth interviews and focus group discussions in a province of Indonesia with a high TB prevalence. Two districts representing rural and urban areas were selected to obtain information from TB service providers (i.e., physicians and nurses) at the CHC level. In addition, key informant interviews with TB patients, hospital TB specialists, pharmacists, and activists were conducted. The trustworthiness and credibility of the information were established using information saturation, participant validation, and triangulation approaches. The interviews were also transcribed for the inductive analysis using Atlas.ti 8.4 software. We identified 210 meaning units from 48 participants and classified them into two main themes: organizational capacity and TB program activities. We identified the inadequacy of human resources, facility, and external coordination as the main barriers to organizational capacity. Furthermore, the barriers were identified regarding TB program activities, that is, inadequate TB case finding, diagnosis, drug supply chain and dispensing management, treatment and monitoring, case recording and reporting, and public-private collaboration. Strengthening CHCs in the management of TB is critical to reaching the national and global goals of TB eradication by 2035. These findings can be considered to develop evaluation strategies to improve the successful TB treatment in high prevalent TB countries, especially Indonesia.
社区卫生中心（CHCs）是结核病（TB）服务的主要医疗保健机构。需要识别社区卫生中心层面结核病服务提供者之间的障碍，以帮助他们成功开展结核病治疗。：本研究旨在从结核病高流行国家社区卫生中心层面的结核病服务提供者的角度分析成功治疗结核病的障碍。在印度尼西亚一个结核病高流行的省份，采用深入访谈和焦点小组讨论进行了一项定性研究。选择了代表农村和城市地区的两个区，以获取社区卫生中心层面的结核病服务提供者（即医生和护士）的信息。此外，还对结核病患者、医院结核病专家、药剂师和活动家进行了关键信息访谈。通过信息饱和、参与者验证和三角测量法确定了信息的可信度。访谈内容还使用Atlas.ti 8.4软件进行转录，以便进行归纳分析。我们从48名参与者中识别出210个意义单元，并将它们分为两个主要主题：组织能力和结核病项目活动。我们确定人力资源、设施和外部协调不足是组织能力的主要障碍。此外，还确定了结核病项目活动方面的障碍，即结核病病例发现、诊断、药品供应链和配药管理、治疗和监测、病例记录和报告以及公私合作不足。加强社区卫生中心对结核病的管理对于实现到2035年消除结核病的国家和全球目标至关重要。这些研究结果可用于制定评估策略，以改善结核病高流行国家，特别是印度尼西亚的结核病成功治疗情况。
