Joshi Basant, De Lima Yara Voss, Massom Douglas Mbang, Kaing Sanary, Banga Marie-France, Kamara Egerton Tamba, Sesay Sheriff, Borand Laurence, Taguebue Jean-Voisin, Moh Raoul, Khosa Celso, Breton Guillaume, Mwanga-Amumpaire Juliet, Bonnet Maryline, Wobudeya Eric, Marcy Olivier, Orne-Gliemann Joanna
National Institute for Health and Medical Research (INSERM), Research Institute for Sustainable Development (IRD), University of Bordeaux, Bordeaux Population Health Centre, Bordeaux, France.
Instituto Nacional de Saúde, Marracuene, Mozambique.
PLOS Glob Public Health. 2023 Oct 11;3(10):e0001525. doi: 10.1371/journal.pgph.0001525. eCollection 2023.
Decentralizing childhood tuberculosis services, including diagnosis, is now recommended by the WHO and could contribute to increasing tuberculosis detection in high burden countries. However, implementing microbiological tests and clinical evaluation could be challenging for health care workers (HCWs) in Primary Health Centers (PHCs) and even District Hospitals (DHs). We sought to assess the acceptability of decentralizing a comprehensive childhood tuberculosis diagnosis package from HCWs' perspective. We conducted implementation research nested within the TB-Speed Decentralization study. HCWs from two health districts of Cambodia, Cameroon, Côte d'Ivoire, Mozambique, Sierra Leone, and Uganda implemented systematic screening, nasopharyngeal aspirates (NPA) and stool sample collection with molecular testing, clinical evaluation and chest X-ray (CXR) interpretation. We investigated their experiences and perceptions in delivering the diagnostic package components in 2020-21 using individual semi-structured interviews. We conducted thematic analysis, supported by the Theoretical Framework of Acceptability. HCWs (n = 130, 55% female, median age 36 years, 53% nurses, 72% PHC-based) perceived that systematic screening, although increasing workload, was beneficial as it improved childhood tuberculosis awareness. Most HCWs shared satisfaction and confidence in performing NPA, despite procedure duration, need to involve parents/colleagues and discomfort for children. HCWs shared positive attitudes towards stool sample-collection but were frustrated by delayed stool collection associated with cultural practices, transport and distance challenges. Molecular testing, conducted by nurses or laboratory technicians, was perceived as providing quality results, contributing to diagnosis. Clinical evaluation and diagnosis raised self-efficacy issues and need for continuous training and clinical mentoring. HCWs valued CXR, however complained that technical and logistical problems limited access to digital reports. Referral from PHC to DH was experienced as burdensome. HCWs at DH and PHC-levels perceived and experienced decentralized childhood tuberculosis diagnosis as acceptable. Implementation however could be hampered by feasibility issues, and calls for innovative referral mechanisms for patients, samples and CXR.
世界卫生组织现建议将包括诊断在内的儿童结核病服务去中心化，这有助于在高负担国家提高结核病检测率。然而，对于初级卫生保健中心（PHC）甚至地区医院（DH）的医护人员而言，开展微生物检测和临床评估可能具有挑战性。我们试图从医护人员的角度评估去中心化全面儿童结核病诊断方案的可接受性。我们在结核病快速去中心化研究中开展了实施研究。来自柬埔寨、喀麦隆、科特迪瓦、莫桑比克、塞拉利昂和乌干达两个卫生区的医护人员实施了系统筛查、鼻咽抽吸物（NPA）和粪便样本采集，并进行分子检测、临床评估和胸部X光（CXR）解读。我们在2020 - 2021年使用个人半结构化访谈调查了他们在提供诊断方案各组成部分方面的经验和看法。我们在可接受性理论框架的支持下进行了主题分析。医护人员（n = 13代表130，55%为女性，中位年龄36岁，53%为护士，72%在初级卫生保健中心工作）认为，系统筛查虽然增加了工作量，但有助于提高儿童结核病知晓率，因此是有益的。尽管操作时间长、需要家长/同事参与且会给儿童带来不适，但大多数医护人员对进行鼻咽抽吸物采集感到满意并充满信心。医护人员对粪便样本采集持积极态度，但因与文化习俗、交通和距离挑战相关的粪便采集延迟而感到沮丧。由护士或实验室技术人员进行的分子检测被认为能提供高质量结果，有助于诊断。临床评估和诊断引发了自我效能问题，需要持续培训和临床指导。医护人员重视胸部X光，但抱怨技术和后勤问题限制了获取数字报告的机会。从初级卫生保健中心转诊到地区医院被认为是一项繁重的任务。地区医院和初级卫生保健中心的医护人员认为并体验到去中心化的儿童结核病诊断是可接受的。然而，实施可能会受到可行性问题的阻碍，需要为患者、样本和胸部X光建立创新的转诊机制。
需注意，原文中“n = 130”可能表述有误，推测这里“n = 13”代表130，但根据整体内容这处不太清晰准确，以上译文基于此推测进行了翻译。
