Following Guidelines for Drug-Resistant Tuberculosis: “Yes, it’s a challenge”

Background Drug-resistant tuberculosis (DR-TB) is a major contributor to antimicrobial resistance (AMR) globally and is projected to be responsible for up to a quarter of AMR-associated deaths in the future. Management of DR-TB is increasingly decentralised to primary healthcare settings, and simultaneously becoming more complex due to a growing range of treatment options (e.g. novel agents, shorter regimens). This is reflected in the numerous recent updates to international guidelines and as such understanding the barriers and enablers to how healthcare workers access and use guidelines is vital. Methods We used an established psychological framework – the theoretical domains framework (TDF) – to construct and analyse an online survey and focus groups to explore healthcare workers current use of DR-TB guidelines in South Africa. We aimed to identify barriers and enablers with which to direct future attempts at improving guideline use. Results There were 19 responses to the online survey and 14 participants in two focus groups. 28% used only the most up-to-date national guidelines. The TDF domains of ‘Social Influences’ and ‘Beliefs about Consequences’ were key enablers, with healthcare workers encouraged to use guidelines and also recognising the value in doing so. ‘Environmental Resources’ and ‘Knowledge’ were key barriers with limited, or variable access to guidelines and lack of confidence using them being notable issues. Discussion Current use of DR-TB guidelines in South Africa is suboptimal for a variety of reasons. Planned interventions should focus on overcoming the identified key barriers and might include an increased use of digital tools.