Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia.
Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.
BMC Health Serv Res. 2022 Jun 2;22(1):732. doi: 10.1186/s12913-022-08043-w.
Tuberculosis (TB) is the leading cause of death from a single infectious agent globally, killing about 1.5 million people annually, yet 3 million cases are missed every year. The World Health Organization recommends systematic screening of suspected active TB patients among those visiting the healthcare facilities. While many countries have scaled-up systematic screening of TB, there has been limited assessment of the extent of its integration into the health system. This study sought to explore factors that shape the integration of systematic screening of TB in outpatient departments of primary healthcare facilities in Kitwe district, Zambia.
This was a qualitative case study with health providers including district managers, TB focal point persons and laboratory personnel working in six purposively selected primary healthcare facilities. Data was collected through key informant (n = 8) and in-depth (n = 15) interviews. Data analysis was conducted using QDA Miner software and guided by Atun's Integration framework.
The facilitators to integration of systematic screening for TB into out patient departments of primary health facilities included the perceived high burden TB, compatibility of the systematic screening for TB program with healthcare workers training and working schedules, stakeholder knowledge of each others interest and values, regular performance management and integrated outreach of TB screening services. Constraining factors to integration of systematic screening for TB into outpatient departments included complexity of screening for TB in children, unbalanced incentivization mechanisms, ownership and legitimacy of the TB screening program, negative health worker attitudes, social cultural misconceptions of TB and societal stigma as well as the COVID-19 pandemic.
Systematic screening of TB is not fully integrated into the primary healthcare facilities in Zambia to capture all those suspected with active TB that make contact with the health system. Finding the missing TB cases will, therefore, require contextual adaptation of the systematic screening for TB program to local needs and capacities as well as strengthening the health system.
结核病（TB）是全球范围内单一感染源导致死亡的主要原因，每年导致约 150 万人死亡，但每年仍有 300 万例病例被漏诊。世界卫生组织建议在医疗机构就诊的疑似活动性结核病患者中进行系统筛查。虽然许多国家已经扩大了对结核病的系统筛查，但对其纳入卫生系统的程度的评估有限。本研究旨在探讨在赞比亚基特韦地区的初级保健设施的门诊部中，影响结核病系统筛查纳入程度的因素。
这是一项定性案例研究，涉及 6 家选定的初级保健设施中的卫生提供者，包括区经理、结核病重点人员和实验室人员。通过关键知情人（n=8）和深入访谈（n=15）收集数据。使用 QDA Miner 软件进行数据分析，并以 Atun 的整合框架为指导。
将结核病系统筛查纳入初级保健设施门诊部的促进因素包括：结核病负担高、结核病系统筛查项目与医护人员培训和工作时间相兼容、利益相关者对彼此利益和价值观的了解、定期绩效管理和结核病筛查服务的综合推广。限制结核病系统筛查纳入门诊部的因素包括：儿童结核病筛查的复杂性、激励机制不平衡、结核病筛查项目的所有权和合法性、医护人员的消极态度、对结核病的社会文化误解和社会耻辱感以及 COVID-19 大流行。
在赞比亚，结核病系统筛查尚未完全纳入初级保健设施，无法发现所有与卫生系统接触的疑似活动性结核病患者。因此，要发现漏诊的结核病病例，需要根据当地的需求和能力对结核病系统筛查项目进行调整，并加强卫生系统。
