Health Worker Practices, Facilitators and Barriers towards the Intensified Case-Finding Tuberculosis Screening Tool in Uganda

Introduction Although the Tuberculosis (TB) Intensified Case Finding (ICF) tool was introduced in 2011, only 15.7% of the estimated 35 million people living with HIV were screened for TB in 2013. We explored the facilitators, barriers and health care workers’ practices regarding use of the ICF tool in TB screening. Methods We conducted a qualitative study in Jinja, eastern Uganda. We purposively sampled eight (4 private and 4 Government) health facilities (HFs) with the guidance of the District TB and Leprosy Supervisor (DTLS). At each health facility, three health care workers (in-charge TB clinic, a TB focal person & one laboratory technician (total: 24 participants in 8 HFs) were interviewed using a key informant interview guide. Data were collected on how TB was screened and diagnosed in general and when using the ICF tool in particular. Data were audio-recorded, transcribed in verbatim, coded and analyzed using a thematic framework. Results The ICF tool was available in all the 8 HFs; however, only half (12/24) the health workers interviewed at these facilities had ever used it for screening TB. The facilitators to ICF use were all levels of health cadres could use it, with simple, close-ended questions and clear, simple instructions. However, several barriers were identified as hindering the use of the ICF tool. The barriers to the use of the ICF tool are segmented according to the Health System building blocks, Leadership and Governance Barriers (concurrent use of other tools, lack of detailed training), Health Workforce Barriers (Lack of awareness of about the tool, perceived increased workload) and Health Information Management System Barriers (Stock-outs of the ICF tools). Discussion The ICF tool was found to be simple and easy to use; however, its use remained low due to a variety of perceived barriers by health workers. There is a need to increase the health care workers’ awareness about the ICF tool to improve its utilization in TB screening. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement There was no funding for this study. ### Author Declarations All relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript. Yes All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes It is a qualitative study, there is no data available.