"If I've got latent TB, I would like to get rid of it": Derivation of the CARD (Constraints, Actions, Risks, and Desires) Framework informed by South African healthcare worker perspectives on latent tuberculosis treatment.

<h4>Background</h4>Healthcare workers (HWs) have at least twice the risk of tuberculosis (TB) compared to the general population. There is growing emphasis on latent TB infection (LTBI) in high-risk populations. Yet we know little about HWs' perspectives of LTBI testing and treatmen...

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Autores principales:	Ruvandhi R Nathavitharana, Ananja van der Westhuizen, Helene-Mari van der Westhuizen, Hridesh Mishra, Annalean Sampson, Jack Meintjes, Edward Nardell, Andrew McDowell, Grant Theron
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/b90bde6667a248b0a5f32ea7bbd01d1f
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spelling	oai:doaj.org-article:b90bde6667a248b0a5f32ea7bbd01d1f2021-12-02T20:15:00Z"If I've got latent TB, I would like to get rid of it": Derivation of the CARD (Constraints, Actions, Risks, and Desires) Framework informed by South African healthcare worker perspectives on latent tuberculosis treatment.1932-620310.1371/journal.pone.0254211https://doaj.org/article/b90bde6667a248b0a5f32ea7bbd01d1f2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0254211https://doaj.org/toc/1932-6203<h4>Background</h4>Healthcare workers (HWs) have at least twice the risk of tuberculosis (TB) compared to the general population. There is growing emphasis on latent TB infection (LTBI) in high-risk populations. Yet we know little about HWs' perspectives of LTBI testing and treatment to inform implementation in high-incidence settings. We developed a qualitative networked approach to analyze HWs' perspectives on LTBI testing and treatment.<h4>Methods</h4>We conducted 22 in-depth interviews with nurse and physician stakeholders, who had been recruited as part of a larger study evaluating TB transmission risk in HWs at Tygerberg Hospital, Cape Town, South Africa. We performed open coding to identify emergent themes and selective coding to identify relevant text citations. We used thematic analysis to inductively derive the CARD (Constraints, Actions, Risks, Desires) framework.<h4>Results</h4>All HWs desired to avoid developing TB but few felt this was actionable. Despite LTBI knowledge gaps, safety and cost concerns, most HWs reported hypothetical willingness to take LTBI treatment. The CARD framework showed that desire and action related to LTBI testing and treatment was clearly framed by the interactions between constraints, administrative action, and risk. The surprise HWs described on receiving a negative LTBI (Quantiferon-Plus) result suggests LTBI testing may recalibrate HWs' perceptions regarding the futility of actions to reduce their TB risk.<h4>Conclusions</h4>LTBI testing and treatment are acceptable to HWs and could counteract the perceived inevitability of occupational TB infection that currently may limit risk reduction action. This should be coupled with administrative leadership and infrastructural support. The CARD analytic framework is a helpful tool for implementation scientists to understand current practices within complex health systems. Application of CARD could facilitate the development of contextually-relevant interventions to address important public health problems such as occupational TB.Ruvandhi R NathavitharanaAnanja van der WesthuizenHelene-Mari van der WesthuizenHridesh MishraAnnalean SampsonJack MeintjesEdward NardellAndrew McDowellGrant TheronPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 8, p e0254211 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Ruvandhi R Nathavitharana Ananja van der Westhuizen Helene-Mari van der Westhuizen Hridesh Mishra Annalean Sampson Jack Meintjes Edward Nardell Andrew McDowell Grant Theron "If I've got latent TB, I would like to get rid of it": Derivation of the CARD (Constraints, Actions, Risks, and Desires) Framework informed by South African healthcare worker perspectives on latent tuberculosis treatment.
description	<h4>Background</h4>Healthcare workers (HWs) have at least twice the risk of tuberculosis (TB) compared to the general population. There is growing emphasis on latent TB infection (LTBI) in high-risk populations. Yet we know little about HWs' perspectives of LTBI testing and treatment to inform implementation in high-incidence settings. We developed a qualitative networked approach to analyze HWs' perspectives on LTBI testing and treatment.<h4>Methods</h4>We conducted 22 in-depth interviews with nurse and physician stakeholders, who had been recruited as part of a larger study evaluating TB transmission risk in HWs at Tygerberg Hospital, Cape Town, South Africa. We performed open coding to identify emergent themes and selective coding to identify relevant text citations. We used thematic analysis to inductively derive the CARD (Constraints, Actions, Risks, Desires) framework.<h4>Results</h4>All HWs desired to avoid developing TB but few felt this was actionable. Despite LTBI knowledge gaps, safety and cost concerns, most HWs reported hypothetical willingness to take LTBI treatment. The CARD framework showed that desire and action related to LTBI testing and treatment was clearly framed by the interactions between constraints, administrative action, and risk. The surprise HWs described on receiving a negative LTBI (Quantiferon-Plus) result suggests LTBI testing may recalibrate HWs' perceptions regarding the futility of actions to reduce their TB risk.<h4>Conclusions</h4>LTBI testing and treatment are acceptable to HWs and could counteract the perceived inevitability of occupational TB infection that currently may limit risk reduction action. This should be coupled with administrative leadership and infrastructural support. The CARD analytic framework is a helpful tool for implementation scientists to understand current practices within complex health systems. Application of CARD could facilitate the development of contextually-relevant interventions to address important public health problems such as occupational TB.
format	article
author	Ruvandhi R Nathavitharana Ananja van der Westhuizen Helene-Mari van der Westhuizen Hridesh Mishra Annalean Sampson Jack Meintjes Edward Nardell Andrew McDowell Grant Theron
author_facet	Ruvandhi R Nathavitharana Ananja van der Westhuizen Helene-Mari van der Westhuizen Hridesh Mishra Annalean Sampson Jack Meintjes Edward Nardell Andrew McDowell Grant Theron
author_sort	Ruvandhi R Nathavitharana
title	"If I've got latent TB, I would like to get rid of it": Derivation of the CARD (Constraints, Actions, Risks, and Desires) Framework informed by South African healthcare worker perspectives on latent tuberculosis treatment.
title_short	"If I've got latent TB, I would like to get rid of it": Derivation of the CARD (Constraints, Actions, Risks, and Desires) Framework informed by South African healthcare worker perspectives on latent tuberculosis treatment.
title_full	"If I've got latent TB, I would like to get rid of it": Derivation of the CARD (Constraints, Actions, Risks, and Desires) Framework informed by South African healthcare worker perspectives on latent tuberculosis treatment.
title_fullStr	"If I've got latent TB, I would like to get rid of it": Derivation of the CARD (Constraints, Actions, Risks, and Desires) Framework informed by South African healthcare worker perspectives on latent tuberculosis treatment.
title_full_unstemmed	"If I've got latent TB, I would like to get rid of it": Derivation of the CARD (Constraints, Actions, Risks, and Desires) Framework informed by South African healthcare worker perspectives on latent tuberculosis treatment.
title_sort	"if i've got latent tb, i would like to get rid of it": derivation of the card (constraints, actions, risks, and desires) framework informed by south african healthcare worker perspectives on latent tuberculosis treatment.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/b90bde6667a248b0a5f32ea7bbd01d1f
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"If I've got latent TB, I would like to get rid of it": Derivation of the CARD (Constraints, Actions, Risks, and Desires) Framework informed by South African healthcare worker perspectives on latent tuberculosis treatment.

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