Kusse K. Toitole ^1* Catiane V. Kelen ² Ermias Diro ³ Tullia Battaglioli ²

• ¹ Department of Internal Medicine, Arba Minch General Hospital, Arba Minch, Ethiopia
• ² Department of Public Health, Institute of Tropical Medicine Antwerp, Antwerp, Antwerp, Belgium
• ³ Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

Introduction: In healthcare settings, there is an increased risk of TB infection, both for patients and healthcare workers. The World Health Organization (WHO) policy on TB Infection Control (TB IC) in healthcare facilities includes four sets of control measures: managerial, administrative, environmental, and personal protective equipment. For successful implementation, global and national guidelines need to be adapted based on locally identified barriers and opportunities. This study is aimed at assessing TB IC: practices, gaps, and barriers in healthcare facilities in southern Ethiopia.Methods: A facility-based mixed-methods study was carried out between February and April 2018. Facility assessment was done using a standardized checklist; a self-administered questionnaire was used to complete a knowledge, attitude, and practice (KAP) survey on 237 professionals; and 13 in-depth interviews (IDIs) and six focus group discussions (FGDs) were conducted. The facility assessment results were evaluated against WHO and national standards. The quantitative data were analyzed using descriptive statistics. Thematic analysis method was used to analyze qualitative data.Results: None of the three facilities had an annual TB IC plan or facility TB IC risk assessment. In waiting areas, patients with cough symptoms were not isolated from others, and there was no fast tracking in the laboratory and drug collection area. Only 29.1% of the professionals had ever taken TB IC training, and only 34.6% knew that surgical masks do not protect HCWs by stopping TB particles from being breathed in. Only 36.3% of professionals reported always using N95 or FFP2 when treating patients with cough or presumed TB, and 23.6% never wore N95 masks. Among the participants, 13.5% had ever been treated for TB. IDIs and FGDs identified lack of managerial support, lack of training on TB IC, diagnostic delays, lack of separation area, shortage of masks and respirators, and stigma and lack of awareness among patients and the community as major barriers towards TB IC practice.Conclusions: Lack of managerial support, including TB IC plan and training, unsuitable facility setup, stigma and lack of awareness among patients and community, lack of supplies, and diagnostic delays were identified as major barriers. There is a need for an urgent intervention.