A QUALITATIVE STUDY OF KNOWLEDGE, ATTITUDE AND PRACTICE TOWARDS TB IN GEORGIA.

TB remains to be the major public health concern in Georgia. TB awareness and knowledge is usually low in the general population, which leads to delayed referral to a medical facility, which in turn hinders timely initiation of diagnostic and treatment interventions. Lack of knowledge also contributes much to the widespread stigma in the society. The aim of the study was to qualitatively explore TB knowledge, attitudes and practice, as well as related barriers and facilitators by conducting FGDs among representatives of general population as well as TB risk groups. The qualitative data was collected through FGDs among different target groups: (1) TB patients; (2) TB contacts; (3) Injecting drug users; (4) health care providers and (5) students. FGD recordings were transcribed using a predefined coding scheme and followed by contextual analysis. According to the study results, there is a good level of TB knowledge and awareness among current/former TB patients, their contacts, and health care providers, which is linked to their practice and experience. IDUs receive sufficient information on the disease within the educational component of the Needle and Syringe program. A significant lack of TB knowledge was revealed in a segment of the general population such as students. Lack of TB knowledge among general population is highly linked to the stigmatized attitude towards TB patients. Accurate TB knowledge is an important prerequisite determining positive attitude towards the disease and supporting stigma reduction. Correct information on TB should be disseminated through all possible channels and the process should have permanent nature.

Private primary health care provider delay in tuberculosis diagnosis and treatment in Georgia.

SETTING: One national and two regional tuberculosis (TB) hospitals in Georgia. OBJECTIVES: To define the factors associated with private primary health care (PPHC) provider delay in TB diagnosis and treatment. DESIGN: This was a cross-sectional study of data collected from consecutive patients with pulmonary TB from July 2015 to August 2016, complemented by qualitative data collected among PPHC providers/managers, TB patients and policy makers. RESULTS: PPHC provider delay (>2 weeks from the first medical consultation for TB symptoms to the initiation of TB treatment) occurred in 43.8% of 320 TB patients. Modifiable factors significantly associated with PPHC provider delay included receiving any non-specific treatment before diagnosis of TB (adjusted OR [aOR] 9.45, 95%CI 5.10-17.51), adequate knowledge of TB (aOR 0.35, 95%CI 0.12-0.99) and lower TB-related stigma (aOR 0.47, 95%CI 0.28-0.81). Inappropriate referral of presumptive TB patients to general health facilities for chest X-ray examination, often followed by misinterpretation of X-ray results in these facilities, might mislead PPHC providers to initiate presumptive TB patients on non-specific treatment. CONCLUSION: PPHC provider delay in TB diagnosis and treatment is common in Georgia, highlighting a need for targeted interventions to improve identification and referral of presumptive TB patients to specialised TB services and Xpert testing.