Treating latent TB in primary care: a survey of enablers and barriers among UK General Practitioners.
BACKGROUND
Treating latent tuberculosis infection (LTBI) is an important public health intervention. In the UK, LTBI treatment is delivered in secondary care. Treating LTBI in the community would move care closer to home and could increase uptake and treatment completion rates. However, healthcare providers' views about the feasibility of this in the UK are unknown. This is the first study to investigate perceived barriers and enablers to primary care-based LTBI treatment among UK general practitioners (GPs).


METHODS
A national survey amongst 140 randomly sampled UK GPs practising in areas of high TB incidence was performed. GPs' experience and perceived confidence, barriers and enablers of primary care-based LTBI treatment were explored and multivariable logistic regression was used to determine whether these were associated with a GP's willingness to deliver LTBI treatment.


RESULTS
One hundred and twelve (80 %) GPs responded. Ninety-three (83 %; 95 % CI 75 %-89 %) GPs said they would be willing to deliver LTBI treatment in primary care, if key perceived barriers were addressed during service development. The major perceived barriers to delivering primary care-based LTBI treatment were insufficient experience among GPs of screening and treating LTBI, lack of timely specialist support and lack of allied healthcare staff. In addition, GPs felt that appropriate resourcing was key to the successful and sustainable delivery of the service. GPs who reported previous experience of screening or treatment of patients with active or latent TB were almost ten times more likely to be willing to deliver LTBI treatment in primary care compared to GPs with no experience (OR: 9.98; 95 % CI 1.22-81.51).


CONCLUSIONS
UK GPs support primary care-based LTBI treatment, provided they are given appropriate training, specialist support, staffing and financing.
Department of Primary Care and Public Health, Imperial College London, Room 332, Reynolds Building, Charing Cross Campus, London, W6 8RF, UK. christina.atchison11@imperial.ac.uk.
Christina
C
Atchison
Centre for Infectious Disease Surveillance and Control, Public Health England, London, NW9 5EQ, UK. dominik.zenner@phe.gov.uk.|Centre for Infectious Disease Epidemiology, University College London, London, NW1 2DA, UK. dominik.zenner@phe.gov.uk.|National Institute for Health Research Health Protection Research Unit in Respiratory Infections, Imperial College London, London, W6 8RF, UK. dominik.zenner@phe.gov.uk.
Dominik
D
Zenner
Department of Primary Care and Public Health, Imperial College London, Room 332, Reynolds Building, Charing Cross Campus, London, W6 8RF, UK. lily.barnett18@hotmail.com.
Lily
L
Barnett
Centre for Infectious Disease Surveillance and Control, Public Health England, London, NW9 5EQ, UK. manish.pareek@leicester.ac.uk.|Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, LE1 9HN, UK. manish.pareek@leicester.ac.uk.
Manish
M
Pareek
D000328:Adult; D001291:Attitude of Health Personnel; D003144:Communication Barriers; D003695:Delivery of Health Care; D005260:Female; D058005:General Practitioners; D006801:Humans; D055985:Latent Tuberculosis / Q000188:drug therapy*; D016015:Logistic Models; D008297:Male; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D013222:State Medicine; D011795:Surveys and Questionnaires; D006113:United Kingdom