Table 4 Next steps
Steps to take | Time frame | Construct |
|---|---|---|
Present the importance of data-driven work that can support clinical care and not just be extra paperwork | 2–3 months | Design packaging |
Ensure senior management are on-board with the program and up-to-date with recent guidelines | 2–3 months | Leadership/relative priority |
Hold monthly, rotating journal clubs for doctors and nurses to discuss case studies and evidence for TPT and guidelines | 2–3 months | Access to knowledge |
Hold community events and meetings with community stakeholders to increase awareness about TPT and decrease stigma associated with TB and HIV (perhaps males) | 2–3 months | Culture |
Ensure pharmacists and clinics can adequately stock TPT medications | 2–3 months | Implementation readiness |
Ensure regular communication through WhatsApp groups and email lists from pharmacists to clinic teams about TPT stock supply in the district | 2–3 months | Implementation readiness |
Provide simple point-of-care guidelines and visual algorithms in clinics and use during trainings | 2–3 months | Knowledge/evidence |
Using local champions and community leaders to recruit community members, host regular community sessions on importance of TPT and why asymptomatic people should screen for TB and initiate TPT | 3–6 months | Knowledge |
Engage HCWs in small group trainings (or 1:1) about the evidence of TPT | 3–6 months | Evidence, knowledge |
Hold regular in-person/virtual trainings for nurses on TB infection, diagnosis, and TPT dosing to increase confidence in ruling out active disease and initiating the TPT dosing | 3–6 months | Self-efficacy/knowledge |
Improve engagement with CHWs for TB programming | 3–6 months | Culture/implementation readiness |
Take advantage of existing nurse champions to lead TB programming | 3–6 months | Champions/implementation readiness |
Identify at least one community medication pick up point for each clinic to reduce travel distance for patients to collect medications | 3–6 months | Design quality/packaging |
Identify one community champion per clinic and train them on mobilizing the community around the importance of screening and testing for TB, de-stigmatizing TB and HIV, and organizing TPT awareness campaigns | 3–6 months | Champions |
Improve consistency of internet connectivity at clinics for trainings, access to information on TPT, and sharing of data | 6 months–1 year | Implementation readiness |
Engage policy stakeholders at the regional, provincial, and national level on integrating TPT into clinical practice guidelines, educational preparation for clinicians, and continuous professional development activities | 6 months–1 year | Champions |