Barriers to Optimal Tuberculosis Treatment Services at Community Health Centers: A Qualitative Study From a High Prevalent Tuberculosis Country

Ivan S Pradipta; Lusiana R Idrus; Ari Probandari; Irma Melyani Puspitasari; Prayudi Santoso; Jan-Willem C Alffenaar; Eelko Hak

doi:10.3389/fphar.2022.857783

Barriers to Optimal Tuberculosis Treatment Services at Community Health Centers: A Qualitative Study From a High Prevalent Tuberculosis Country

Front Pharmacol. 2022 Mar 25:13:857783. doi: 10.3389/fphar.2022.857783. eCollection 2022.

Authors

Ivan S Pradipta^{1

2}, Lusiana R Idrus^{3

4}, Ari Probandari^{5

6}, Irma Melyani Puspitasari^{1

2}, Prayudi Santoso⁷, Jan-Willem C Alffenaar^{8

9

10

11}, Eelko Hak³

Affiliations

¹ Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia.
² Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia.
³ Unit of Pharmaco-Therapy, Pharmaco-Epidemiology and Pharmaco-Economics (PTE2), Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands.
⁴ Bekasi General Hospital, West Java Local Government, Bekasi, Indonesia.
⁵ Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia.
⁶ Disease Control Research Group, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia.
⁷ Division of Respirology and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
⁸ Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW, Australia.
⁹ Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, NSW, Australia.
¹⁰ Werstmead Hospital, Sydney, NSW, Australia.
¹¹ Department of Clinical Pharmacy and Pharmacology, University Medical Centrum Groningen, Groningen, Netherlands.

Abstract

Background: Community health centers (CHCs) are a backbone healthcare facility for tuberculosis (TB) services. Identifying barriers amongst TB service providers at the CHC level is required to help them deliver successful TB treatment. Aims: The current study aimed to analyze barriers to successful TB treatment from the perspective of TB service providers at the CHC level in a high prevalent TB country. Methods: A qualitative study was conducted using in-depth interviews and focus group discussions in a province of Indonesia with a high TB prevalence. Two districts representing rural and urban areas were selected to obtain information from TB service providers (i.e., physicians and nurses) at the CHC level. In addition, key informant interviews with TB patients, hospital TB specialists, pharmacists, and activists were conducted. The trustworthiness and credibility of the information were established using information saturation, participant validation, and triangulation approaches. The interviews were also transcribed for the inductive analysis using Atlas.ti 8.4 software. Results: We identified 210 meaning units from 48 participants and classified them into two main themes: organizational capacity and TB program activities. We identified the inadequacy of human resources, facility, and external coordination as the main barriers to organizational capacity. Furthermore, the barriers were identified regarding TB program activities, that is, inadequate TB case finding, diagnosis, drug supply chain and dispensing management, treatment and monitoring, case recording and reporting, and public-private collaboration. Conclusion: Strengthening CHCs in the management of TB is critical to reaching the national and global goals of TB eradication by 2035. These findings can be considered to develop evaluation strategies to improve the successful TB treatment in high prevalent TB countries, especially Indonesia.

Keywords: Indonesia; healthcare problems; qualitative; tuberculosis; tuberculosis barriers.