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“It’s too hard” – the management of latent TB in under-served populations in the UK: a qualitative study
BACKGROUND: UK national guidance recommends systematic screening for latent tuberculosis infection (LTBI) in under-served populations, including people experiencing homelessness and people who use drugs. This is not routinely implemented in the UK, and the reasons for this policy-practice mismatch r...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9715280/ https://www.ncbi.nlm.nih.gov/pubmed/36457026 http://dx.doi.org/10.1186/s12913-022-08855-w |
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author | Gray, Adam Thorburn Surey, Julian Esmail, Hanif Story, Alistair Harris, Magdalena |
author_facet | Gray, Adam Thorburn Surey, Julian Esmail, Hanif Story, Alistair Harris, Magdalena |
author_sort | Gray, Adam Thorburn |
collection | PubMed |
description | BACKGROUND: UK national guidance recommends systematic screening for latent tuberculosis infection (LTBI) in under-served populations, including people experiencing homelessness and people who use drugs. This is not routinely implemented in the UK, and the reasons for this policy-practice mismatch remain underexplored. METHODS: Semi-structured qualitative interviews were conducted with 19 healthcare professionals from across the UK. Participants were recruited using purposive sampling and snowballing, identifying individuals with excellent knowledge of their regions practice and policy of LTBI management. The interviews were conducted online, and were audio recorded, with transcripts thematically analysed using a two-stage inductive coding process to explore perceived barriers and enablers to LTBI screening. RESULTS: Most participants had previous experience managing LTBI in under-served populations, but none were conducting systematic screening as per national guidance. We identified service provision challenges and low prioritisation of LTBI as the key explanatory themes driving this policy-practice mismatch. Lack of resource, and the complexity of clinical decision making were two key service level barriers. System and service inertia, and lack of cost effectiveness evidence led to LTBI being deprioritised. Service integration and promotion of WHO targets for TB elimination were highlighted as potential solutions. CONCLUSION: Integrating LTBI testing and treatment with existing health services for under-served populations could improve feasibility and efficacy. Promotion of UK TB elimination goals and generation of regional evidence to support commissioning for LTBI care is vital. Without such a multi-pronged approach inertia is likely to persist and the zeitgeist will remain: “it’s too hard”. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-08855-w. |
format | Online Article Text |
id | pubmed-9715280 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-97152802022-12-02 “It’s too hard” – the management of latent TB in under-served populations in the UK: a qualitative study Gray, Adam Thorburn Surey, Julian Esmail, Hanif Story, Alistair Harris, Magdalena BMC Health Serv Res Research BACKGROUND: UK national guidance recommends systematic screening for latent tuberculosis infection (LTBI) in under-served populations, including people experiencing homelessness and people who use drugs. This is not routinely implemented in the UK, and the reasons for this policy-practice mismatch remain underexplored. METHODS: Semi-structured qualitative interviews were conducted with 19 healthcare professionals from across the UK. Participants were recruited using purposive sampling and snowballing, identifying individuals with excellent knowledge of their regions practice and policy of LTBI management. The interviews were conducted online, and were audio recorded, with transcripts thematically analysed using a two-stage inductive coding process to explore perceived barriers and enablers to LTBI screening. RESULTS: Most participants had previous experience managing LTBI in under-served populations, but none were conducting systematic screening as per national guidance. We identified service provision challenges and low prioritisation of LTBI as the key explanatory themes driving this policy-practice mismatch. Lack of resource, and the complexity of clinical decision making were two key service level barriers. System and service inertia, and lack of cost effectiveness evidence led to LTBI being deprioritised. Service integration and promotion of WHO targets for TB elimination were highlighted as potential solutions. CONCLUSION: Integrating LTBI testing and treatment with existing health services for under-served populations could improve feasibility and efficacy. Promotion of UK TB elimination goals and generation of regional evidence to support commissioning for LTBI care is vital. Without such a multi-pronged approach inertia is likely to persist and the zeitgeist will remain: “it’s too hard”. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-08855-w. BioMed Central 2022-12-01 /pmc/articles/PMC9715280/ /pubmed/36457026 http://dx.doi.org/10.1186/s12913-022-08855-w Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Gray, Adam Thorburn Surey, Julian Esmail, Hanif Story, Alistair Harris, Magdalena “It’s too hard” – the management of latent TB in under-served populations in the UK: a qualitative study |
title | “It’s too hard” – the management of latent TB in under-served populations in the UK: a qualitative study |
title_full | “It’s too hard” – the management of latent TB in under-served populations in the UK: a qualitative study |
title_fullStr | “It’s too hard” – the management of latent TB in under-served populations in the UK: a qualitative study |
title_full_unstemmed | “It’s too hard” – the management of latent TB in under-served populations in the UK: a qualitative study |
title_short | “It’s too hard” – the management of latent TB in under-served populations in the UK: a qualitative study |
title_sort | “it’s too hard” – the management of latent tb in under-served populations in the uk: a qualitative study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9715280/ https://www.ncbi.nlm.nih.gov/pubmed/36457026 http://dx.doi.org/10.1186/s12913-022-08855-w |
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