Challenges in the implementation of preventive treatment for tuberculosis in people living with HIV/Aids: A qualitative study

Abstract

AbstractTreatment of tuberculosis infection (TBI) in people living with HIV/Aids (PLWHA) reduces the risk of tuberculosis disease (TBD), the main cause of death in this population. Recognizing the barriers related to the scale up of tuberculosis preventive treatment (TPT) can contribute to reorganization of health services for achieving TB elimination. This qualitative study aimed to understand the perception of specialized care health professionals of a capital city in Brazil about TPT for PLWHA. Between October 2020 and August 2022 ten physicians and four nurses working for more than six months in reference HIV/Aids services were interviewed. Interviews were guided by a script of previously validated, semi-structured questions. The audios were recorded, transcribed, and categorized based on Grounded Theory, and its analysis was anchored in the theoretical framework of Symbolic Interactionism. Sampling was performed using theoretical saturation. The emerged central phenomenon “Facing challenges in the implementation of TPT in the light of scientific evidence” was supported by four categories:1) Demonstrating theoretical knowledge regarding TBI and its treatment guidelines; 2) Dealing with the complexities of guidelines adherence in the routine service; 3) Building bonds to overcome different challenges in the care of PLWHA; 4) Seeking strategies to facilitate adherence to the TPT guidelines service. Professionals faced challenges in implementing TPT due to structural obstacles in service, hesitation in establishing therapy, and the risk of adverse events when dealing with patients’ vulnerabilities, despite available scientific evidence, theoretical knowledge, and guidelines recommendations. They envisaged ideal conditions to adhere to the TPT guidelines in service, and seeked to mediate confrontations by strengthening their bond with patients through multidisciplinary interaction, teaching, and research.