Acceptability of Tuberculosis Preventive Treatment for Household Contacts in Moulvibazar District, Bangladesh: An Implementation Research

Nighat Sultana, Prof dr Yodi Mahendradhata, Dr dr Ida Safitri L.

2023 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Pencegahan Tuberkulosis (TB) dengan pengobatan preventif merupakan langkah penting dalam memberantas TBC. Dalam beberapa tahun terakhir, beberapa negara, termasuk Bangladesh, telah memperbarui program nasional pengendalian TBC agar semua kontak rumah tangga termasuk dalam cakupan Pengobatan Pencegahan TBC (TPT). Namun, penelitian mengenai hambatan dan tantangan spesifik konteks mengenai penerimaan TPT masih langka.
Tujuan: Penelitian ini bertujuan untuk mengetahui akseptabilitas TPT bagi kontak serumah baik dari sudut pandang pelaksana maupun kontak.
Metode: Penelitian implementasi ini mengikuti pendekatan metode campuran konvergen yang dipandu oleh kerangka cascade perawatan TPT. Lokasinya di distrik Moulvibazar, Bangladesh. Data kuantitatif sekunder yang diperoleh dari National TB Control Program (NTP), Bangladesh, digunakan untuk menentukan hasil cakupan TPT melalui analisis deskriptif. Bagian kualitatif mencakup pendekatan analisis tematik untuk mengeksplorasi faktor-faktor yang mempengaruhi tinggi rendahnya penyelesaian langkah-langkah kaskade. Peserta wawancara dipilih melalui purposive sampling
Hasil: Dari bulan April hingga Desember 2022, teridentifikasi 7.297 kontak rumah tangga dan 3.105 (43%) di antaranya memulai TPT. Perawatan pencegahan kurang dapat diterima oleh kontak. Mereka mempertanyakan alasan pengobatan untuk ‘tidak ada penyakit’ dan khawatir tentang efek samping obat dan kemungkinan stigma. Konseling kontak sebelum memulai TPT, persepsi kerentanan terhadap TB, dukungan keluarga, layanan kesehatan gratis, dan program penjangkauan diidentifikasi sebagai fasilitator. Pihak kesehatan menerima TPT sebagai bagian yang efektif dan penting dalam strategi pengendalian TBC. Namun, kekurangan infrastruktur, termasuk kehabisan obat-obatan dan tidak tersedianya fasilitas investigasi, serta kekurangan staf terampil menghambat proses implementasi.
Kesimpulan: TPT dapat diterima di kalangan pelaksana dan kurang dapat diterima di kalangan kontak. Pendekatan yang berorientasi pada kontak dan peningkatan kapasitas di tingkat fasilitas kemungkinan besar akan meningkatkan penerimaan TPT di Bangladesh.

Background: Preventing Tuberculosis (TB) by preventive treatment is a crucial step toward eliminating TB. In recent years, several countries, including Bangladesh, have updated national TB control programs to bring all household contacts under TB Preventive Treatment (TPT) coverage. However, research on context-specific barriers and challenges regarding TPT acceptability is scarce.
Objectives: This study aimed to explore the acceptability of TPT for household contacts from both implementers’ and contacts’ perspectives.
Method: This implementation research followed a convergent mixed-method approach guided by the TPT care cascade framework. The setting was Moulvibazar district, Bangladesh. Secondary quantitative data, obtained from the National TB Control Programme (NTP), Bangladesh, were used to determine the yield of TPT coverage through descriptive analysis. The qualitative part included a thematic analysis approach to explore the factors influencing the high or low completion of the cascade steps. Interview participants were chosen through purposive sampling.
Results: From April to December 2022, 7,297 household contacts were identified and 3,105 (43%) of them initiated TPT. Preventive treatment was less acceptable to the contacts. They questioned the reasoning for treatment for ‘no disease’ and were concerned about drug side effects and possible stigma. Counseling contacts before starting TPT, perceived susceptibility to TB, family support, free healthcare services, and outreach programs were identified as facilitators. Health accepted TPT as an effective and important part of TB control strategy. However, infrastructural inadequacy, including medicine stock-out and unavailability of investigation facilities, and shortage of skilled staff were hindering the implementation process.
Conclusion: TPT is acceptable among implementers and less acceptable among contacts. Contact-oriented approach and capacity building at the facility level are likely to improve the TPT acceptance in Bangladesh.

Kata Kunci : TPT, tuberculosis preventive treatment, implementation research, acceptability, household contact