背景：结核病（TB）是全世界死亡的主要原因，中国结核病负担在全球排名第二。中国初级医疗保健（PHC）部门实施结核病控制计划（TCP）以改善主动病例发现，转介,治疗依从性，和健康教育。本研究旨在确定在中国西部高结核病负担地区实施TCP的障碍和促成因素。
方法：我们于2021年10月至2022年5月在中国西部的重庆市和贵州省的28个县或地区进行了混合方法的代表性研究。对PHC部门的2720名结核病医护人员（HCWs）和20名受访者进行了问卷调查和半结构化深入访谈。描述性统计分析用于调查TBHCW的特征，并利用路径分析模型分析了相关因素对TCP实现的影响。主题框架分析是在改编的实施研究综合框架（CFIR）关于TCP实施因素的指导下开发的。
结果：这项研究发现，84.6％和94.1％的社区和乡村HCW的职称较低。根据多元回归分析和相关分析的结果,较低的结核病核心知识得分(-0.09)被认为是社区PHC部门实施TCP的障碍，低工作满意度（-0.17）和低工作意愿（-0.10）是农村PHC部门实施TPC的障碍。深入访谈的结果报告了CFIR的所有领域的障碍和四个领域的推动者。确定了19个与TCP实现相关的CFIR结构，包括22个障碍，如HCWs繁重的工作量，以及12个推动者，如HCWs对TCP规划的热情。
结论：在CFIR框架的指导下，探索了中国西部地区PHC部门实施TCP的复杂因素(障碍和促成因素)，这为在高结核病负担地区推广结核病计划提供了重要证据。迫切需要进行进一步的执行研究，将这些因素转化为执行战略。
BACKGROUND: Tuberculosis (TB) is a major cause of death worldwide, and Chinese TB burden ranked the second globally. Chinese primary healthcare (PHC) sectors implement the TB Control Program (TCP) to improve active case finding, referral, treatment adherence, and health education. This study aimed to identify barriers and enablers of TCP implementation in high TB burden regions of West
China.
METHODS: We conducted a representative study using mixed-methods in 28 counties or districts in Chongqing Municipality and Guizhou Province of West
China from October 2021 to May 2022. Questionnaire surveys and semi-structured in-depth interviews were conducted with 2720 TB healthcare workers (HCWs) and 20 interviewees in PHC sectors. Descriptive statistical analysis was used to investigate TB HCWs\' characteristics, and path analysis model was utilized to analyze the impact of associated factors on TCP implementation. Thematic framework analysis was developed with the guide of the adapted Consolidated Framework for Implementation Research (CFIR) on factors of TCP implementation.
RESULTS: This study found that 84.6% and 94.1% of community and village HCWs had low professional titles. Based on the results of multiple regression analysis and correlation analysis, lower TB core knowledge scores (-0.09) were identified as barriers for TCP implementation in community PHC sectors, and low working satisfaction (-0.17) and low working willingness (-0.10) are barriers for TPC implementation in village PHC sectors. The results of in-depth interviews reported barriers in all domains and enablers in four domains of CFIR. There were identified 19 CFIR constructs associated with TCP implementation, including 22 barriers such as HCWs\' heavy workload, and 12 enablers such as HCWs\' passion towards TCP planning.
CONCLUSIONS: With the guide of the CFIR framework, complex factors (barriers and enablers) of TCP implementation in PHC sectors of West
China were explored, which provided important evidences to promote TB program in high TB burden regions. Further implementation studies to translate those factors into implementation strategies are urgent needed.
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