Organizational Readiness for the Implementation of a Three-Month Short-Course TB Preventive Therapy Regimen (3HP) in Four Health Care Facilities in Zimbabwe in 2020: A Mixed Methods Study

Abstract BackgroundTuberculosis preventive therapy (TPT) for latent TB infection has had limited success in Zimbabwe. The country plans to roll-out the three-month short-course TPT regimen (3HP) to address the implementation lag and poor uptake of the 6-9-month regimens. The study measured the level of organizational readiness while identifying barriers and facilitators to implement 3HP in four health facilities in Zimbabwe. MethodsA convergent, parallel mixed-methods approach was used to collect data from four primary healthcare clinics in Bulawayo and Harare Metropolitan provinces, Zimbabwe. Twenty healthcare providers completed a 35-item, self-administered questionnaire designed on a 5-point Likert scale and developed from the Weiner organizational readiness model. Nine of the providers and five TB program managers took part in 20-30 minute individual semi-structured key-informant interviews. Median scores with interquartile ranges were calculated wherein a score of 3.3 or greater indicated readiness. Differences between facilities were assessed using a Kruskal-Wallis rank test. Qualitative data on barriers and facilitators were transcribed and analyzed using a framework approach. ResultsReadiness to implement 3HP across the four facilities was positive with a score of 3.8(IQR 3.3-4.1). The difference between the best 4.0(IQR 3.8-4.2) and worst-performing facility 3.2(IQR 2.7-3.3) was 0.8 and statistically significant (p=0.039). The low facility score was due to poor contextual factors 2.5(IQR 2.0-3.3), task demands 2.6(IQR 2.3-2.9), and resource availability 2.1(IQR 1.5-2.5) scores. Key organizational readiness facilitators included healthcare provider and management buy-in; community willingness to generate demand for 3HP; strong collective capability through task-shifting, alignment with existing primary healthcare programs, perceived benefits, and need for 3HP. Barriers were negative past TPT experiences, suboptimal programmatic monitoring, inconsistent health provider remuneration, inadequate staffing, added workload, and an erratic supply chain across facilities. The organizational communication gap prompts the slow program implementation culture. ConclusionsThe varied scores between facilities suggest distinct underlying conditions for readiness. Healthcare provider motivation is temporary based on the inconsistent resource supply, absence of TPT-specific monitoring and evaluation, and daily contextual challenges in facilities that must be addressed. Similar research is necessary for countries yet to implement 3HP to optimize the design or revision of delivery strategies and increase uptake of TPT.