Facilitators and barriers for completion of the diagnostic process among people with presumed tuberculosis in Central Uganda

Uganda has improved its tuberculosis (TB) diagnostic processes over the years since the scale up of the Xpert MTB/RIF testing in 2012. However, there are continued delays in diagnosis and missing people with TB who are either not diagnosed or notified. We explored facilitators and barriers for completion of the TB diagnostic process among people with presumed TB in selected health facilities in Central Uganda. This was a qualitative exploration involving 25 in-depth interviews with people with presumed TB and six sex stratified focus group discussions with people with TB who had recently initiated treatment. We also conducted 20 key informant interviews with health workers providing TB services. All interviews and discussions were audio recorded and transcribed verbatim. Thematic analysis was carried out using Atlas.ti software version 6.0 guided by the constructs of the socio-ecological model. Key facilitators for completion of the TB diagnostic process included; individual factors (persistent symptoms and the desire to get better, obtaining same day results and prior TB knowledge); community (social support); and health system factors (caring health workers and calling of patients to collect results). Barriers were; individual factors (TB and HIV stigma, inability to produce sputum, lack of transport to return to the health facility); and health system factors (long turnaround time of results, stock out of supplies, unclear appointment for collection of results, inadequate patient contact details and negative health worker attitude). Completion of the TB diagnostic process is influenced by individual, health system and community related factors. To enhance completion, there is need for availing same day results, making clear appointments for collection of results and improving health worker attitudes at the health facility level. At the individual and community level, TB/HIV stigma reduction interventions, community health education on TB and provision of social support to patients with presumed TB should be emphasized.