title: Factors influencing health care workers' implementation of tuberculosis contact tracing in Kweneng, Botswana.
abstract: BACKGROUND
  TB contact tracing rates remain low in high burden settings and reasons for this are not well known. We describe factors that influence health care workers' (HCW) implementation of TB contact tracing (CT) in a high TB burden district of Botswana.
  
  
  METHODS
  Data were collected using questionnaires and in-depth interviews in 31 of the 52 health facilities in Kweneng East Health District. Responses were summarized using summary statistics and comparisons between HCW groups were done using parametric or non-parametric tests as per normality of the data distribution.
  
  
  RESULTS
  One hundred and four HCWs completed questionnaires. Factors that influenced HCW TB contact tracing were their knowledge, attitudes and practices as well as personal factors including decreased motivation and lack of commitment. Patient factors included living further away from the clinic, unknown residential address and high rates of migration and mobility. Administrative factors included staff shortages, lack of transport, poor reporting of TB cases and poor medical infrastructure e.g. suboptimal laboratory services. A national HCW strike and a restructuring of the health system emerged as additional factors during in-depth interviews of TB coordinators.
  
  
  CONCLUSIONS
  Multiple factors lead to poor TB contact tracing in this district. Interventions to increase TB contact tracing will be informed by these findings.
authors: University of Botswana School of Medicine, Gaborone, Botswana.
authors: Lebapotswe
authors: L
authors: Tlale
authors: Perelman School of Medicine, University of Pennsylvania , Philadelphia, USA; Masters of Public Health Program, School of Medicine and School of Social Policy & Practice, Philadelphia, USA.
authors: Rosemary
authors: R
authors: Frasso
authors: Kweneng East District Health Management Team TB Unit, Molepolole, Botswana.
authors: Onalenna
authors: O
authors: Kgosiesele
authors: University of Botswana School of Medicine, Gaborone, Botswana.
authors: Mpho
authors: M
authors: Selemogo
authors: Botswana Accountancy College, Gaborone, Botswana.
authors: Quirk
authors: Q
authors: Mothei
authors: University of Botswana School of Medicine, Gaborone, Botswana.
authors: Dereje
authors: D
authors: Habte
authors: University of Botswana School of Medicine, Gaborone, Botswana; Perelman School of Medicine, University of Pennsylvania , Philadelphia, USA; Botswana-UPenn Partnership, Gaborone, Botswana; Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors: Andrew
authors: A
authors: Steenhoff
mesh_terms: D001902:Botswana; D016358:Contact Tracing / Q000379:methods*; D003695:Delivery of Health Care / Q000458:organization & administration; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D009042:Motivation; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology
keywords: Tuberculosis; guidelines; policy