Determinants of Tuberculosis Infection Control-Related Behaviors among Healthcare Workers in the Country of Georgia

OBJECTIVE To better understand tuberculosis (TB) infection control (IC) in healthcare facilities (HCFs) in Georgia. DESIGN A cross-sectional evaluation of healthcare worker (HCW) knowledge, beliefs and behaviors toward TB IC measures including latent TB infection (LTBI) screening and treatment of HCWs. SETTING Georgia, a high-burden multidrug-resistant TB (MDR-TB) country. PARTICIPANTS HCWs from the National TB Program and affiliated HCFs. METHODS An anonymous self-Administered 55-question survey developed based on the Health Belief Model (HBM) conceptual framework. RESULTS In total, 240 HCWs (48% physicians; 39% nurses) completed the survey. The overall average TB knowledge score was 61%. Only 60% of HCWs reported frequent use of respirators when in contact with TB patients. Only 52% of HCWs were willing to undergo annual LTBI screening; 48% were willing to undergo LTBI treatment. In multivariate analysis, HCWs who worried about acquiring MDR-TB infection (adjusted odds ratio [aOR], 1.7; 95% confidence interval [CI], 1.28-2.25), who thought screening contacts of TB cases is important (aOR, 3.4; 95% CI, 1.35-8.65), and who were physicians (aOR, 1.7; 95% CI, 1.08-2.60) were more likely to accept annual LTBI screening. With regard to LTBI treatment, HCWs who worked in an outpatient TB facility (aOR, 0.3; 95% CI, 0.11-0.58) or perceived a high personal risk of TB reinfection (aOR, 0.5; 95% CI, 0.37-0.64) were less likely to accept LTBI treatment. CONCLUSION The concern about TB reinfection is a major barrier to HCW acceptance of LTBI treatment. TB IC measures must be strengthened in parallel with or prior to the introduction of LTBI screening and treatment of HCWs.