Perceptions, preferences, and experiences of tuberculosis education and counselling among patients and providers in Kampala, Uganda: A qualitative study

ABSTRACT

Tuberculosis (TB) education seeks to increase patient knowledge about TB, while TB counselling seeks to offer tailored advice and support for medication adherence. While universally recommended, little is known about how to provide effective, efficient, patient-centred TB education and counselling (TEC) in low-income, high HIV-TB burden settings. We sought to characterise stakeholder perceptions of TEC in a public, primary care facility in Kampala, Uganda, by conducting focus group discussions with health workers and TB patients in the TB and HIV clinics. Participants valued TEC but reported that high-quality TEC is rarely provided, because of a lack of time, space, staff, planning, and prioritisation given to TEC. To improve TEC, they recommended adopting practices that have proven effective in the HIV clinic, including better specifying educational content, and employing peer educators focused on TEC. Patients and health workers suggested that TEC should not only improve TB patient knowledge and adherence, but should also empower and assist all those undergoing evaluation for TB, whether confirmed or not, to educate their households and communities about TB. Community-engaged research with patients and front-line providers identified opportunities to streamline and standardise the delivery of TEC using a patient-centred, peer-educator model.

KEYWORDS:

• Patient-centred
• patient education
• counselling
• patient preferences
• HIV
• sub-Saharan Africa
• implementation science
• Uganda
• peer education
• peer navigation
• tuberculosis

Acknowledgements

We would like to thank and acknowledge the critical contributions of study participants from Kisenyi Health Center; Kampala Capital City Authority; the Uganda National TB and Leprosy Programme leadership; Uganda TB Implementation Research Consortium staff; and research administrators at the Makerere University College of Health Sciences. Dr. Irene Ayakaka acknowledges the support of the NIHR Global Health Research Unit on Lung Health and TB in Africa (IMPALA) and the NIH FIC Pulmonary Complications of AIDS Research Training Grant.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

Funding was provided by the National Institute of Allergy and Infectious Diseases (NIH R01AI104824 to J. Lucian Davis), the Fogarty International Center (NIH D43TW009607 to J. Lucian Davis) and a Pilot Award from the Yale University Center for Interdisciplinary Research on AIDS to J. Lucian Davis and Sheela Shenoi, supported by a parent grant from the National Institute of Mental Health (P30MH062294). Dr. Irene Ayakaka was supported by the National Institute for Health Research under the Global Health Research Unit on Lung Health and TB in Africa "IMPALA" program at LSTM. IMPALA was funded by a grant from the UK government through the National Institute for Health Research support to global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health & Social Care.