Summary of themes and sub-themes.

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 私人卫生机构（Private Health Facilities, PHFs）是乌干达主要的医疗服务提供方，在国家结核病（TB）规划提升结核病病例报告率、抗击结核病流行的工作中属于不可或缺的利益相关主体。然而，相较公立医疗机构，私人卫生机构的结核病病例报告率仍相对偏低。本研究旨在评估坎帕拉首都城市区内私人医疗机构开展结核病病例报告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（cross-sectional study），采用混合研究方法（mixed-methods approach）评估结核病病例报告的促进与阻碍因素。在定量研究环节，我们通过结构化调查问卷（structured questionnaire）对224家私人卫生机构的结核病协调人进行了访谈；在定性研究环节，我们对乌干达卫生部工作人员、坎帕拉分区行政层面及私人卫生机构的结核病协调人开展了14次关键知情人访谈（key informant interviews）与深度访谈（in-depth interviews）。定量分析采用改良泊松回归（Modified Poisson regression）法，定性分析则通过主题分析（thematic analysis）识别结核病病例报告的促进因素与阻碍因素。 结果 在受访的224家私人卫生机构中，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）。研究发现，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）的医疗机构结核病病例报告率显著更低。未配备结核病筛查与诊断指南的医疗机构（PR=0.50；95%CI：0.25, 0.97），以及机构内其他卫生工作人员的结核病诊断培训情况不明的医疗机构（PR=0.35；95%CI：0.13, 0.93），其结核病病例报告率同样偏低。定性数据显示，结核病病例报告的主要促进因素包括：国家结核病规划（NTLP）与私人卫生机构的常态化联动，以及为开展病例筛查提供物资与支持；而主要阻碍因素则包括结核病污名化（TB stigma）以及缺乏结核病诊断设施等各类资源。 结论 坎帕拉首都城市区内的私人卫生机构对项目化的结核病病例报告工作持接纳态度，但仍需常态化的督导与联动活动，以确保其掌握更新后的专业知识、配备相应设备并获得资金支持，从而依照政策要求规范开展结核病病例报告工作。