Exploring facilitators and barriers to early TB case finding at private community pharmacies in Kampala, Uganda using the Consolidated Framework for Implementation Research (CFIR).

BACKGROUND

Tuberculosis (TB) remains one of the leading global infectious diseases killer, with Uganda among the countries bearing the highest TB/HIV burden. The World Health Organization’s (WHO) ambitious End TB strategy by 2030 emphasizes the strong involvement of private healthcare providers in TB efforts. In line with this, Uganda has adopted the WHO’s public-private mix (PPM) model. This study explored the facilitators and barriers to engaging private community pharmacies in the early detection of TB cases in Kampala, Uganda. DESIGN/

METHODS

We conducted a qualitative study at five private community pharmacies in Kampala. We used in-depth interviews with healthcare providers (HCPs) who dispense medications at private community pharmacies (nurses and pharmacy technicians), pharmacy clients, and key informant interviews with pharmacy owners/managers. Data was analyzed using an inductive thematic approach, identifying themes as barriers or facilitators to engaging private community pharmacies in TB case finding. These themes were then mapped to the Consolidated Framework for Implementation Research (CFIR) domains and constructs.

RESULTS

Facilitators of TB screening at private community pharmacies include: pharmacy staff’s willingness to be trained and collaborate with healthcare professionals to screen for TB. Healthcare providers acknowledge TB as a serious public health threat and view community pharmacies as valuable partners in early detection and prevention. Leveraging existing community awareness and targeted communication campaigns can further enhance patient engagement in TB screening services. The barriers identified include limited space and the high facility expansion costs, inadequate access to TB screening tools and equipment, and persistent stigma and public misconceptions about TB that may deter patients from seeking screening. Pharmacy staff also face knowledge gaps, resource constraints, and potential revenue losses from referring patients to hospitals.

CONCLUSIONS

These findings provide a basis for designing contextually appropriate interventions targeting factors that are likely to promote the engagement of private community pharmacies in Uganda in early TB case findings. Future studies should assess the impact of addressing identified barriers.