Madison Maia, Vambe Debrah, Thi Sein Sein, Ziyane Mangaliso, Shiba Nosisa, Nkala Babongile Blisset, Ness Tara, Lima Agostinho Viana, Dlamini Sindisiwe, Ngwenya Siphiwe, Mandalakas Anna, Kay Alexander
Baylor College of Medicine Children's Foundation Eswatini, Mbabane, Eswatini.
Fulbright U.S. Student Program, New York, New York, United States of America.
PLOS Glob Public Health. 2025 Jun 12;5(6):e0004718. doi: 10.1371/journal.pgph.0004718. eCollection 2025.
Challenges in diagnosing drug-resistant tuberculosis (DR-TB) contribute to a diagnostic gap. Design-locked Targeted Sequencing (TS) assays have the potential to improve DR-TB diagnosis and management. TS assays are now being introduced into low-income, high TB burden settings. Eswatini is among the first high burden countries to have implemented TS for patient care. To evaluate the impact of the current program and optimize future implementation, we evaluated healthcare provider knowledge, attitudes, and perceptions (KAP) of TS and its implementation. We conducted semi-structured interviews with healthcare providers. Interviews were continued until data saturation was reached and analyzed by directed thematic analysis. The study was conducted at 85% of all DR-TB treatment centers (12/14) in rural and urban settings across all four regions in Eswatini. We interviewed nine doctors and eight nurses who were purposively sampled from DR-TB care sites in Eswatini. We found that providers' experience, roles, and settings informed their knowledge and perceptions of DR-TB diagnosis and management. While all healthcare providers wanted to improve comprehensive drug susceptibility testing, operational challenges with the existing program shaped their KAP of TS. In some instances, providers reported that results from TS on sputum improved their ability to provide quality DR-TB patient care. However, they perceived a need for improvements in the delivery of TS results and desired more training to inform their current use of results from sputum and potential future use of results from stool. Overall, healthcare providers recognized TS as an important new tool with the potential to improve DR-TB patient care. However, they also recognized the need for additional healthcare worker training, community engagement, forecasting to avoid reagent shortages, and enhanced medical information systems. Investments in these areas would likely support more effective and sustainable implementation in Eswatini and other LMICs with high TB burdens.
耐药结核病（DR-TB）诊断面临的挑战导致了诊断差距。设计锁定靶向测序（TS）检测方法有潜力改善耐药结核病的诊断和管理。目前，TS检测方法正在被引入低收入、结核病负担高的地区。斯威士兰是最早将TS检测用于患者治疗的高负担国家之一。为了评估当前项目的影响并优化未来的实施，我们评估了医疗服务提供者对TS检测及其实施的知识、态度和看法（KAP）。我们对医疗服务提供者进行了半结构化访谈。访谈持续进行，直至达到数据饱和，并通过定向主题分析进行分析。该研究在斯威士兰所有四个地区城乡的所有耐药结核病治疗中心的85%（12/14）进行。我们采访了从斯威士兰耐药结核病护理点有目的地抽取的9名医生和8名护士。我们发现，医疗服务提供者的经验、角色和工作环境影响了他们对耐药结核病诊断和管理的知识和看法。虽然所有医疗服务提供者都希望改进综合药敏试验，但现有项目的操作挑战影响了他们对TS检测的KAP。在某些情况下，医疗服务提供者报告说，痰液TS检测结果提高了他们提供优质耐药结核病患者护理的能力。然而，他们认为在TS检测结果的提供方面需要改进，并希望接受更多培训，以便了解他们目前对痰液检测结果的使用情况以及未来可能对粪便检测结果的使用情况。总体而言，医疗服务提供者认识到TS检测是一种重要的新工具，有潜力改善耐药结核病患者的护理。然而，他们也认识到需要对医护人员进行更多培训、开展社区参与、进行预测以避免试剂短缺，以及加强医疗信息系统。在这些领域的投资可能会支持在斯威士兰和其他结核病负担高的低收入和中等收入国家更有效和可持续地实施该项目。
