Assessing provider adherence to guidelines for screening and treatment of latent tuberculosis infection

Assessing provider adherence to guidelines for screening and treatment of latent tuberculosis infection

Latent tuberculosis infection (LTBI) is a condition in which a person is infected with Mycobacterium tuberculosis, the bacterium that causes tuberculosis (TB), but does not have any symptoms or signs of active TB disease. LTBI is a major risk factor for developing active TB disease, especially in people who have weakened immune systems, such as those living with HIV. Therefore, screening and treatment of LTBI are important strategies to prevent TB transmission and reduce the global burden of TB.

However, the implementation of LTBI screening and treatment programs faces many challenges, such as low awareness, limited resources, poor adherence, and adverse effects of treatment. To address these challenges, the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) have issued updated and consolidated guidelines for the programmatic management of LTBI in different populations at risk of developing TB. These guidelines provide evidence-based recommendations on who should be tested for LTBI, how to test for LTBI, and what treatment regimens to use for LTBI.

The aim of this paper is to assess the adherence of health care providers to these guidelines for screening and treatment of LTBI in various settings and populations. We will review the literature on the barriers and facilitators of provider adherence to LTBI guidelines, as well as the interventions that have been implemented or evaluated to improve provider adherence. We will also discuss the implications of provider adherence for TB control and elimination, and suggest areas for future research and action.

We will use the following research questions to guide our literature review:

– What are the current guidelines for screening and treatment of LTBI issued by WHO and CDC?
– What are the factors that influence provider adherence to LTBI guidelines?
– What are the interventions that have been implemented or evaluated to improve provider adherence to LTBI guidelines?
– What are the outcomes and impacts of provider adherence to LTBI guidelines on TB prevention and control?

We will conduct a systematic search of the following databases: PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar. We will use a combination of keywords and MeSH terms related to LTBI, screening, treatment, guidelines, adherence, and health care providers. We will include studies published in English from 2020 to 2023 that report on provider adherence to LTBI guidelines in any setting or population. We will exclude studies that focus on patient adherence or satisfaction, or that do not measure or report on provider adherence. We will use the PRISMA checklist to report our search strategy, study selection, data extraction, quality assessment, and data synthesis.

We will use a narrative synthesis approach to summarize and synthesize the findings from the included studies. We will use descriptive statistics to report the frequency and distribution of studies by setting, population, guideline, outcome, and intervention. We will use thematic analysis to identify and categorize the main themes and subthemes related to the factors influencing provider adherence, the types and components of interventions to improve provider adherence, and the outcomes and impacts of provider adherence on TB prevention and control. We will use GRADE criteria to assess the quality of evidence and strength of recommendations from each study.

We expect to find a heterogeneous body of literature on provider adherence to LTBI guidelines, reflecting the diversity of settings, populations, guidelines, outcomes, and interventions involved. We anticipate that provider adherence will be influenced by multiple factors at individual, organizational, system, and policy levels. We also expect that interventions to improve provider adherence will vary in their design, implementation, evaluation, effectiveness, cost-effectiveness, scalability, and sustainability. We hope that our review will provide a comprehensive overview of the current state of knowledge on provider adherence to LTBI guidelines, as well as identify gaps and priorities for future research and action.

References:

– CDC. Guidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020. MMWR Recomm Rep 2020;69(No. RR-1):1–11.
– WHO. Latent tuberculosis infection: updated and consolidated guidelines for programmatic management. Geneva: World Health Organization; 2018.
– WHO. Guidelines on the management of latent tuberculosis infection. Geneva: World Health Organization; 2015.