Barriers to Tuberculosis Contact Investigation Implementation in Ghana: A Convergent Mixed-Methods Study

Abstract Background Tuberculosis (TB) contact investigation identifies and manages individuals exposed to TB and supports early detection. However, implementation in high-burden settings faces challenges, and evidence on patient-level concerns and organizational barriers to TB contact investigation in Ghana is scarce. This study examined patient contact disclosure and patient-reported concerns, and explored provider-reported organizational and contextual barriers to implementation in selected healthcare facilities in Ghana's Ashanti Region Methods We conducted a convergent mixed-methods study across six healthcare facilities in three districts. Among 212 adults with pulmonary TB, quantitative data were collected using a structured questionnaire, and 25 healthcare providers participated in in-depth interviews. Patients were recruited consecutively and providers were purposively selected. Quantitative data were analyzed using descriptive statistics, chi-square tests, and logistic regression analyses. Qualitative data underwent deductive-inductive thematic analysis using the Consolidated Framework for Implementation Research (CFIR) as an analytic lens, and quantitative and qualitative findings were integrated during interpretation. Results Among the 212 participants, 82.5% had heard of TB contact investigation, 55.7% reported at least one contact, and 44.3% reported none. Among those reporting contacts, 71 reported fewer than four contacts and 47 reported four or more. Knowledge level was not significantly associated with contact disclosure (χ² = 2.717, p = 0.257). In the adjusted analysis, participants aged 25–34 years (adjusted odds ratio [AOR] = 2.64, 95% Confidence Interval [CI]: 1.06–6.54; p = 0.036) and 45–54 years (AOR = 3.18, 95% CI: 1.42–7.13; p = 0.005) had higher odds of reporting contact disclosure than those aged ≥ 55 years. Frequently reported interpersonal concerns included family privacy (46.2%), fear of blame (43.9%), fear of judgment (40.1%), and concern that contacts might experience stigma if screened (38.2%). Providers reported workload, competing responsibilities, limited counselling time, transport constraints, staffing limitations, and coordination challenges. Conclusions TB contact investigation in setting occurred in multilevel context involving patient-reported concerns and provider-reported organizational and logistical constraints. Strengthening implementation may require patient-centered counselling addressing confidentiality, stigma and blame, alongside adequate time, staffing, transport and coordination support.