ArticleBMJ open respiratory research2025
Health system-related barriers and facilitators to tuberculosis preventive treatment: a qualitative case study comparing implementation in the Republic of Moldova and Georgia.
Article in BMJ open respiratory research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Bridging Programmatic Gap in Post-TB Treatment Prevention: Applying the COM-B Model and Behavior Change Wheel to Improve the Uptake of TB Preventive Therapy.Open forum infectious diseases · 2026Article
- "Now that I took TPT, it's affecting my ART adherence, viral load, even my wellbeing in the community". Exploring acceptability and experience of Tuberculosis Preventive Treatment among adolescents living with HIV in Zimbabwe.PLOS global public health · 2025Article
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Authors and funding
7 authors.
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Abstract
introductionDespite WHO's recommendations and the 2023-2030 Tuberculosis (TB) action plan, uptake of TB preventive treatment (TPT) remains suboptimal. In this paper, we use two countries of the WHO Europe Region, the Republic of Moldova and Georgia, that are at different stages of implementation of TB prevention policies, as a case study to examine health system barriers and facilitators to TPT scale-up.
methodsIn this case study, we used methods of qualitative research-interviews with three stakeholder groups: health service providers and National TB Programme staff; civil society organisations and international partners or donors. The data were collected via videoconference, transcribed, then coded and analysed using NVivo V.14. Thematic analysis was conducted.
resultsFacilitators for TPT delivery in both settings include an established TB clinical network, well-functioning communication systems and an uninterrupted supply of TPT medicines.In both settings, healthcare providers generally exhibit positive attitudes towards treating TB infection; however, some remain sceptical and cautious, particularly regarding prescribing TPT without confirmation of TB infection, a challenge compounded by limited access to testing for TB infection. Evidence of TB infection is also important for patients' decisions on initiation and adherence to treatment. Other barriers to effective service delivery of TPT include shortages and high workload of primary healthcare personnel, ambiguity in the role of family doctors in the management of TPT and low prioritisation of TPT during regular monitoring visits.
conclusionsThe case study identified similar challenges in the rollout of TPT across both settings, highlighting common barriers hindering effective implementation. For optimal TPT rollout, enhancing provider confidence, improving access to testing for TB infection and strengthening integration with primary healthcare with refined roles of family doctors are essential. Both settings would also benefit from improved monitoring and evaluation systems and prioritisation of TB prevention in monitoring.
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