Barriers and facilitators of implementing a latent tuberculosis infection (LTBI) case management program in a primary care setting
- 1Centers for Disease Control and Prevention
Abstract
ContextApproximately 80% of tuberculosis (TB) disease in the United States arises from untreated latent TB infection (LTBI). Primary care clinics are well positioned to address LTBI in populations disproportionately affected by TB, yet implementation barriers remain poorly characterized.
ObjectiveIdentify barriers and facilitators encountered during early implementation of a multidisciplinary LTBI case management intervention (CMI) in a federally qualified health center (FQHC) serving predominantly non-U.S.-born patients.
DesignQualitative study using structured key informant interviews, analyzed with iterative thematic analysis. Staff and patients were conveniently sampled; patients were limited to those who completed treatment.
Setting and ParticipantsThree clinics within a FQHC in Seattle, Washington. Thirty-seven interviews were conducted (32 staff, 5 patients) from February 2023-May 2024.
Main Outcome MeasuresStaff- and patient-reported barriers and facilitators to CMI implementation.
ResultsStaff identified three barriers: 1) adapting to a new workflow, including technical challenges and role ambiguity; 2) clinic capacity and resource constraints, including staffing and limited language support; and 3) gaps in LTBI care, particularly chest radiograph access and patient questions after a positive test. Staff reported three facilitators: 1) division of labor through role-shifting, enabling detection of side effects and dosing errors; 2) standardized communication tools and educational materials improving consistency and staff confidence; and 3) collaboration via electronic messaging and structured meetings supporting iterative improvement. Patients mostly reported facilitators only, citing the proactive follow-up as central to treatment completion. Both groups cited the drug shortage as a barrier to treatment completion.
ConclusionsMultidisciplinary case management revealed facilitators and barriers in delivering coordinated care. Staff identified division of labor, standardized tools, and structured communication key to care coordination while patients emphasized staff encouragement and pro-active follow-up as central to treatment completion. Workflow integration, resource capacity, and post-diagnosis patient support should be considered when implementing or scaling similar models.
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BibTeX
@misc{rahman2026barriers,
title = {{Barriers and facilitators of implementing a latent tuberculosis infection (LTBI) case management program in a primary care setting}},
author = {M. Rahman and R. Calderara and S. Chansombath and M. Narita and Y. Sorri and for the Tuberculosis Epidemiologic Studies Consortium},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.23.26366327},
url = {https://www.medrxiv.org/content/10.64898/2026.10.23.26366327v1},
note = {CC0},
}
RIS
TY - UNPB
TI - Barriers and facilitators of implementing a latent tuberculosis infection (LTBI) case management program in a primary care setting
AU - M. Rahman
AU - R. Calderara
AU - S. Chansombath
AU - M. Narita
AU - Y. Sorri
AU - for the Tuberculosis Epidemiologic Studies Consortium
PY - 2026
DA - 2026/10/23
PB - medRxiv
DO - 10.64898/2026.10.23.26366327
UR - https://www.medrxiv.org/content/10.64898/2026.10.23.26366327v1
AB - ContextApproximately 80% of tuberculosis (TB) disease in the United States arises from untreated latent TB infection (LTBI). Primary care clinics are well positioned to address LTBI in populations disproportionately affected by TB, yet implementation barriers remain poorly characterized. ObjectiveIdentify barriers and facilitators encountered during early implementation of a multidisciplinary LTBI case management intervention (CMI) in a federally qualified health center (FQHC) serving predominantly non-U.S.-born patients. DesignQualitative study using structured key informant interviews, analyzed with iterative thematic analysis. Staff and patients were conveniently sampled; patients were limited to those who completed treatment. Setting and ParticipantsThree clinics within a FQHC in Seattle, Washington. Thirty-seven interviews were conducted (32 staff, 5 patients) from February 2023-May 2024. Main Outcome MeasuresStaff- and patient-reported barriers and facilitators to CMI implementation. ResultsStaff identified three barriers: 1) adapting to a new workflow, including technical challenges and role ambiguity; 2) clinic capacity and resource constraints, including staffing and limited language support; and 3) gaps in LTBI care, particularly chest radiograph access and patient questions after a positive test. Staff reported three facilitators: 1) division of labor through role-shifting, enabling detection of side effects and dosing errors; 2) standardized communication tools and educational materials improving consistency and staff confidence; and 3) collaboration via electronic messaging and structured meetings supporting iterative improvement. Patients mostly reported facilitators only, citing the proactive follow-up as central to treatment completion. Both groups cited the drug shortage as a barrier to treatment completion. ConclusionsMultidisciplinary case management revealed facilitators and barriers in delivering coordinated care. Staff identified division of labor, standardized tools, and structured communication key to care coordination while patients emphasized staff encouragement and pro-active follow-up as central to treatment completion. Workflow integration, resource capacity, and post-diagnosis patient support should be considered when implementing or scaling similar models.
ER -