Table 2 Barriers to implementing TB preventive therapy into a comprehensive TB program in a rural setting by CFIR domain and construct

Intervention characteristics

 Formal training of HCWs

Knowledge, evidence strength

 Knowledge of government pharmaceutical procurement protocols and schedules

Complexity/access to knowledge and information

 Lab processing time, patients have to wait overnight at hospital for results

Complexity

Outer setting

 Transportation

Needs of community

 Time and money to get to clinics

Needs of community

 Education regarding TPT

Needs of community

 Increased pill burden

Needs of community/patients

 Not feeling sick, so why take medicine

Patient needs and resources

Inner setting

 Majority of community HCW’s are based in clinics and not in community

Readiness for implementation

 Stock outs of medication

Readiness for implementation

 Concerns around regimens, toxicity, and prescribing

Readiness for implementation/access to knowledge and information

 Ongoing debate/lack of consensus about IPT among healthcare providers

Readiness for implementation/relative priority

 Network/connectivity not always reliable at clinics, challenging to do online trainings, upload data, etc

Readiness for implementation/available resources

 Competing prioritization of TPT in clinics and hospitals

Priorities, culture

 Community stigma associated with TB and HIV

Compatibility

Characteristics of individuals

 Limited training of healthcare workers on clinical assessment, may contribute to missing cases

Knowledge and beliefs about the intervention

 Challenging access to the community because of poor roads and infrastructure

Complexity/readiness for implementation

 Communities are not taking DS-TB as seriously compared with HIV or DR-TB

Knowledge and beliefs about the intervention

 Flexibility in health provider’s visit/agenda with patients

Implementation climate/relative priority

 Fear of making a mistake or a misdiagnosis

Self-efficacy/knowledge of intervention