Factors associated with low tuberculosis preventive therapy prescription rates among health care workers in rural South Africa

Figures & data

Table 1. Descriptive characteristics of indirect and direct TPT providers

Variables N (%) or median (±IQR)	All respondents (n = 160)	Indirect TPT providers (n = 83)	Direct TPT providers (n = 71)	P-value
Age, years	39 (± 13)	38 (± 11)	41.5 (± 16.75)	0.01
Female	75.6% (121/159)	73.5% (61/83)	78.6% (55/70)	0.46
Primary healthcare clinics	78.1% (125/160)	79.5% (66/83)	74.6% (53/71)	0.47
District hospital	21.9% (35/160)	20.5% (17/83)	25.4% (18/71)	0.49
Professional nurse	37.5% (60/160)	16.9% (14/83)	62.0% (44/71)	< 0.01
Staff nurse	31.9% (51/160)	41.0% (34/83)	23.9% (17/71)	0.03
VCT counselor	10.6% (17/160)	19.3% (16/83)	0% (0/71)	< 0.01
Medical officer	6.3% (10/160)	0% (0/83)	14.1% (10/71)	< 0.01
Other position	13.1% (21/160)	22.9% (19/83)	0% (0/71)	< 0.01

Figure 1. Flowchart of factors generated by exploratory factor analysis (EFA) of survey questions

Table 2. Knowledge, attitudes, and beliefs among direct TPT providers (n = 71)

Themes	Factors	Frequency, % (n/N)
I. HCW Knowledge of TPT	Good self-reported TPT knowledge	90.0% (63/70)
	Good knowledge of TPT guidelines	53.7% (36/67)
II. HCW Beliefs on Patient Stigma concerning TPT	Perception of increased patient stigma towards TPT	60.0% (42/70)
	Perception of poor patient comfort with TPT disclosure	60.6% (43/71)
III. HCW Attitudes concerning TPT	Concern about TPT adverse events	77.5% (55/71)
	Positive attitude towards TPT	98.6% (68/69)
	Negative attitude towards TPT	62.9% (44/70)
IV. HCW Beliefs on Patient Factors concerning TPT	Good patient knowledge of TPT	88.6% (62/70)
	Good patient attitude & practices towards TPT	90.1% (64/71)
V. Organizational Level Factors concerning TPT	Sufficient training to counsel patients on TPT	81.7% (58/71)
	Sufficient time to counsel on TPT	95.8% (68/71)
	Sufficient isoniazid supply	93.0% (66/71)

Table 3. Factors associated with low TPT prescription rates (n = 71)

	Odds ratios (95% confidence intervals)
	Unadjusted OR (95%CI)	Multivariable adjusted OR (95%CI)*
Demographics
Age, years	0.99 (0.94–1.04) p = 0.68	**
Female	0.55 (0.16–1.83) p = 0.33	**
Length of time as a healthcare worker, years	0.99 (0.94–1.04) p = 0.67	**
Length of time managing HIV, years	1.01 (0.93–1.10) p = 0.78	**
HCW Knowledge of TPT
Poor self-reported TPT knowledge	5.41 (0.91–32.29) p = 0.06	**
Poor knowledge of TPT guidelines	0.61 (0.22–1.70) p = 0.34	**
HCW Beliefs on Patient Stigma concerning TPT
Perception of increased patient stigma towards TPT	1.43 (0.49–4.18) p = 0.52	**
Perception of poor patient comfort with TPT disclosure	4.71 (1.61–13.38) p = 0.01	4.19 (1.35–13.00) p = 0.01
HCW Attitudes concerning TPT
Concern about TPT adverse events	0.62 (0.19–2.01) p = 0.42	**
Negative attitude towards TPT	2.90 (0.74–11.41) p = 0.13	**
Patient Factors concerning TPT
Perception of poor patient TPT knowledge	3.26 (0.66–16.05) p = 0.15	**
Perception of poor patient attitude & practices towards TPT	1.74 (0.35–8.52) p = 0.50	**
Organizational Level Factors concerning TPT
Insufficient training	4.01 (1.11–14.57) p = 0.04	**
Insufficient time to counsel	4.70 (0.40–54.84) p = 0.22	**
Insufficient isoniazid supply	10.44 (1.09–99.86) p = 0.04	10.10 (0.95–106.92) P = 0.06

*Adjusted for poor self-reported knowledge, perception of poor patient comfort with TPT disclosure, insufficient training, and insufficient isoniazid supply

Figure 2. CFIR model of TPT implementation in rural South Africa. Domains most likely to benefit from further refinement are marked with yellow stars (adapted from Damschroder et al.)