Characteristics of facilities and respondents.

IntroductionPrivate Health Facilities (PHFs), Uganda’s main healthcare providers, are indispensable stakeholders in the national tuberculosis (TB) program’s efforts to improve TB case notification and combat the epidemic. However, notification rates remain relatively low in PHFs compared to public providers. In this study, we sought to assess facilitators and barriers to TB case notification among private facilities in Kampala Capital City.MethodsWe conducted a cross-sectional study utilizing a mixed-methods approach to assess facilitators and barriers to TB notification in Kampala Capital City between March and July 2022. For the quantitative strand of the study, we interviewed the TB focal persons at 224 PHFs using a structured questionnaire and for the qualitative, we conducted 14 key informant and in-depth interviews with Ministry of Health-Uganda staff, and TB focal persons at the Kampala Division administration level and at the PHFs. The quantitative analysis involved Modified Poisson regression and the qualitative analysis was carried out using thematic analysis to identify the facilitators and barriers to TB case notification.ResultsOf the 224 PHFs surveyed, the majority, 39.3%(88), were facilities in Nakawa division and 55.4% (124) of the respondents were male, with a mean age of 32.6 years (SD = 8.6). We found that the prevalence of TB case notification was significantly lower for facilities in Kawempe (PR 0.16; 95%CI 0.05,0.47) and Nakawa (PR 0.39, 95%CI 0.21,0.73). Notification was lower among facilities that had no guide for TB screening and diagnosis (PR 0.50; 95%CI 0.25,0.97) and among those facilities where training of other health workers at the facility in TB diagnosis was unknown (PR 0.35; 95%CI 0.13,0.93). Qualitative data showed that the main facilitators of TB case notification were: regular engagements between the NTLP and private health providers and, provision of materials and support to conduct case finding, while the main barriers included TB stigma, lack of resources such as TB diagnostic facilities.ConclusionsPHFs in Kampala Capital City are receptive to programmatic TB case notification. However, they need regular supervision and engagement activities to ensure that they have updated knowledge, equipment and funding support to carry out TB case notification according to policy.引言 私立卫生机构（Private Health Facilities, PHFs）作为乌干达主要的医疗服务供给主体，是国家结核病（Tuberculosis, TB）防控项目提升结核病例报告率、遏制疫情蔓延不可或缺的核心利益相关方。然而，相较公立医疗机构，私立卫生机构的结核病例报告率仍处于较低水平。本研究旨在评估坎帕拉首都城市区内私立医疗机构开展结核病例报告工作的促进因素与阻碍因素。 方法 本研究于2022年3月至7月在坎帕拉首都城市区内开展横断面研究，采用混合研究方法评估结核病例报告工作的促进与阻碍因素。定量研究环节，我们通过结构化问卷对224家私立卫生机构的结核防控协调人进行访谈；定性研究环节则对乌干达卫生部工作人员、坎帕拉分区行政层面及私立卫生机构的结核防控协调人开展14次关键知情人访谈与深度访谈。定量分析采用改良泊松回归模型，定性分析通过主题分析法识别结核病例报告工作的促进因素与阻碍因素。 结果 在受访的224家私立卫生机构中，39.3%（88家）位于纳卡瓦分区，55.4%（124名）的受访者为男性，平均年龄为32.6岁（标准差（standard deviation, SD）=8.6）。研究显示，卡文佩分区（患病率比（Prevalence Ratio, PR）=0.16；95%置信区间（Confidence Interval, CI）：0.05, 0.47）与纳卡瓦分区（PR=0.39；95%CI：0.21, 0.73）的医疗机构结核病例报告率显著更低。未配备结核筛查与诊断指南的医疗机构（PR=0.50；95%CI：0.25, 0.97），以及机构内其他医护人员结核诊断培训情况不明的医疗机构（PR=0.35；95%CI：0.13, 0.93），其结核病例报告率同样偏低。定性数据表明，推动结核病例报告工作的主要促进因素包括：国家结核与麻风病防控项目（National Tuberculosis and Leprosy Control Program, NTLP）与私立卫生机构的常态化联动，以及为病例发现工作提供物资与支持；而主要阻碍因素则包括结核病污名化，以及缺乏结核诊断相关设施等资源。 结论 坎帕拉首都城市区内的私立卫生机构对项目化结核病例报告工作持接纳态度，但仍需通过常态化督导与联动活动，确保其掌握更新的专业知识、配备相应设备并获得资金支持，以符合政策要求开展结核病例报告工作。