AUTHOR=Mussie Kirubel M., Gradmann Christoph , Yimer Solomon , Manyazewal Tsegahun 

TITLE=Pragmatic Management of Drug-Resistant Tuberculosis: A Qualitative Analysis of Human Resource Constraints in a Resource-Limited Country context—Ethiopia

JOURNAL=International Journal of Public Health

VOLUME=Volume 66 - 2021

YEAR=2021

URL=https://www.ssph-journal.org/journals/international-journal-of-public-health/articles/10.3389/ijph.2021.633917

DOI=10.3389/ijph.2021.633917

ISSN=1661-8564

ABSTRACT=Introduction: Existing evidence suggest that drug-resistant tuberculosis (DR-TB) remains a huge public health threat in resource-limited, high-burden TB countries such as Ethiopia. The pragmatic management of DR-TB is constrained by wider socioeconomic and structural factors, among which human resource challenges are part of. The purpose of this qualitative study was to explore the challenges of health care workers (HCWs) involved in providing DR-TB care in Addis Ababa, Ethiopia. 
Materials and methods: 18 HCWs participated in this study. They were purposively selected from 10 health care facilities in Addis Ababa, Ethiopia, which include both federal level TB specialised centres and primary health care facilities. We in-depth interviewed each participant about their challenges in working as DR-TB health care provider. We then transcribed the audiotaped interviews and thematically analysed the transcripts using Braun and Clark’s reflexive thematic analysis framework. 
Results: We identified five major themes: (1) the need to learn in the field; (2) fear of DR-TB infection; (3) risk of contracting DR-TB; (4) workload; and (5) resource limitations. Despite the heterogeneity of participants’ training and work experience, these constraints were reflected substantially across all HCWs. 
Conclusion: Our findings highlight major human resource constraints that current DR-TB care policies need to foresee and accommodate. New evidence and best practices on what works in DR-TB care in such resource-limited countries are needed to address implementation gaps and meet global TB strategies. Further research is required to investigate health care facilities service readiness for TB care and applicable modalities to address the challenges of HCWs in resource-scarce settings.