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dc.rights.licenseCreative Commons Attribution 4.0 Unported (CC BY 4.0)
dc.contributor.authorZwama, Gimenneen
dc.contributor.authorDiaconu, Karinen
dc.contributor.authorVoce, Anna S.en
dc.contributor.authorO'May, Fionaen
dc.contributor.authorGrant, Alison D.en
dc.contributor.authorKielmann, Karinaen
dc.identifier.citationZwama, G., Diaconu, K., Voce, A. S., O'May, F., Grant, A. D. & Kielmann, K. (2021) Health system influences on the implementation of tuberculosis infection prevention and control at health facilities in low-income and middle-income countries: A scoping review. BMJ Global Health, 6(5):e004735.en
dc.identifier.uri bmjgh-2020-004735
dc.descriptionGimenne Zwama - ORCID: 0000-0001-9458-522X
dc.descriptionKarina Kielmann - ORCID: 0000-0001-5519-1658
dc.description.abstractBackground Tuberculosis infection prevention and control (TB-IPC) measures are consistently reported to be poorly implemented globally. TB-IPC guidelines provide limited recognition of the complexities of implementing TB-IPC within routine health systems, particularly those facing substantive resource constraints. This scoping review maps documented system influences on TB-IPC implementation in health facilities of low/middle-income countries (LMICs).en
dc.description.abstractMethods We conducted a systematic search of empirical research published before July 2018 and included studies reporting TB-IPC implementation at health facility level in LMICs. Bibliometric data and narratives describing health system influences on TB-IPC implementation were extracted following established methodological frameworks for conducting scoping reviews. A best-fit framework synthesis was applied in which extracted data were deductively coded against an existing health policy and systems research framework, distinguishing between social and political context, policy decisions, and system hardware (eg, information systems, human resources, service infrastructure) and software (ideas and interests, relationships and power, values and norms).
dc.description.abstractResults Of 1156 unique search results, we retained 77 studies; two-thirds were conducted in sub-Saharan Africa, with more than half located in South Africa. Notable sociopolitical and policy influences impacting on TB-IPC implementation include stigma against TB and the availability of facility-specific TB-IPC policies, respectively. Hardware influences on TB-IPC implementation referred to availability, knowledge and educational development of staff, timeliness of service delivery, availability of equipment, such as respirators and masks, space for patient separation, funding, and TB-IPC information, education and communication materials and tools. Commonly reported health system software influences were workplace values and established practices, staff agency, TB risk perceptions and fears as well as staff attitudes towards TB-IPC.
dc.description.abstractConclusion TB-IPC is critically dependent on health system factors. This review identified the health system factors and health system research gaps that can be considered in a whole system approach to strengthen TB-IPC practices at facility levels in LMICs.
dc.description.sponsorshipFunding The support of the Economic and Social Research Council (UK) is gratefully acknowledged. The project is partly funded by the Antimicrobial Resistance Cross Council Initiative supported by the seven research councils in partnership with other funders including support from the GCRF (grant reference: ES/P008011/1).en
dc.relation.ispartofBMJ Global Healthen
dc.titleHealth system influences on the implementation of tuberculosis infection prevention and control at health facilities in low-income and middle-income countries: A scoping reviewen
rioxxterms.typeJournal Article/Reviewen
qmu.authorZwama, Gimenneen
qmu.authorDiaconu, Karinen
qmu.authorKielmann, Karinaen
qmu.centreInstitute for Global Health and Developmenten

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Creative Commons Attribution 4.0 Unported (CC BY 4.0)
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