Lima Agostinho Viana, Acácio Sozinho, Cossa Hermínio, Hermans Sabine, Kay Alexander, Ssengooba Willy, Mandalakas Anna, Lange Christoph, Garcia-Basteiro Alberto, Munguambe Khátia
Centro de Investigação Em Saúde da Manhiça (CISM), Maputo, Mozambique.
Department of Global Health, Amsterdam UMC, Location University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands.
BMC Infect Dis. 2025 May 26;25(1):757. doi: 10.1186/s12879-025-11117-9.
Stool-based qPCR TB diagnostics (S-qPCR TBD) are reported to contribute to increased rates of bacteriological confirmation in children and people living with HIV. However, there is still limited literature on the usability, acceptability, and feasibility of S-qPCR TBD in countries with high TB burden. This study aimed to assess healthcare providers' perspectives on usability and perceived barriers and facilitators to the uptake of S-qPCR TBD.
This generic qualitative study was conducted across five health facilities and four communities within the Manhiça District (Mozambique). Twenty-one semi-structured interviews combined with direct observations were conducted with HPs from February 2022 to March 2023. The interviews were transcribed, coded using an Excel matrix, and analyzed using the Diffusion of Innovation theory and the socioecological framework.
The findings suggest that HPs view S-qPCR TBD as easy to perform and beneficial for patients who struggle with sputum production. Intrapersonal factors, such as prior experiences with biological sampling procedures, traumatic experiences with invasive procedures, and understanding of clinical outcomes, are crucial factors positively influencing acceptability. Institutional factors, namely, the clarity of information about S-qPCR TBD, and community factors, such as collaboration between community leaders and health services to facilitate patient referral, were also identified as critical. Societal factors, such as the definition of national guidelines, also play a role. However, potential barriers were identified. These include intrapersonal factors like level of education, employment, distance to health facilities, lack of experience with Stool-based Procedures, and misconceptions about and fears of handling stools. Institutional challenges, such as a lack of clear explanation of the technique, as well as resources and training, delays in consumable replenishment, and machine breakdowns, could also hinder acceptance. Local beliefs about TB transmission also play a role as community-level factors.
While HPs consider S-qPCR TBD as beneficial and easy to perform, acceptability may be compromised by factors such as patients' characteristics, health services challenges, lack of awareness about the S-qPCR TBD, and misconceptions about stool samples and TB. To promote acceptability, the study suggests disseminating information about TB and S-qPCR TBD, improving trust in health services, and fostering collaboration between the health sector and community actors.
据报道，基于粪便的qPCR结核病诊断方法（S-qPCR TBD）有助于提高儿童和艾滋病毒感染者的细菌学确诊率。然而，在结核病负担较高的国家，关于S-qPCR TBD的可用性、可接受性和可行性的文献仍然有限。本研究旨在评估医疗服务提供者对S-qPCR TBD可用性的看法以及采用该方法的感知障碍和促进因素。
这项一般性定性研究在曼希卡区（莫桑比克）的五个卫生设施和四个社区开展。2022年2月至2023年3月，对医疗服务提供者进行了21次半结构化访谈并结合直接观察。访谈内容被转录，使用Excel矩阵进行编码，并运用创新扩散理论和社会生态框架进行分析。
研究结果表明，医疗服务提供者认为S-qPCR TBD易于操作，对咳痰困难的患者有益。个人因素，如既往生物采样程序的经验、侵入性程序的创伤经历以及对临床结果的理解，是对可接受性产生积极影响的关键因素。机构因素，即关于S-qPCR TBD的信息清晰度，以及社区因素，如社区领袖与卫生服务机构之间为便利患者转诊而开展的合作，也被确定为关键因素。社会因素，如国家指南的定义，也发挥着作用。然而，也发现了潜在障碍。这些包括个人因素，如教育水平、就业情况、到卫生设施的距离、缺乏基于粪便程序的经验以及对处理粪便的误解和恐惧。机构方面的挑战，如对该技术缺乏清晰解释以及资源和培训、耗材补充延迟和机器故障，也可能阻碍接受度。关于结核病传播的当地观念作为社区层面的因素也发挥着作用。
虽然医疗服务提供者认为S-qPCR TBD有益且易于操作，但可接受性可能会受到患者特征、卫生服务挑战、对S-qPCR TBD缺乏认识以及对粪便样本和结核病的误解等因素的影响。为提高可接受性，该研究建议传播关于结核病和S-qPCR TBD的信息，增强对卫生服务的信任，并促进卫生部门与社区行为者之间的合作。
