부산대학교 도서관

Rebecca Ingenhoff,1,2 Nicole Robertson,3 Richard Munana,4,5 Benjamin E Bodnar,6 Ivan Weswa,5 Isaac Sekitoleko,7,8 Julia Gaal,1 Bruce J Kirenga,9 Robert Kalyesubula,5,10,11 Felix Knauf,1,11 Trishul Siddharthan12 1Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany; 2Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany; 3University of Kentucky College of Medicine, Lexington, KY, USA; 4School of Public Health, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda; 5African Community Center for Social Sustainability, Nakaseke, Uganda; 6Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 7MRC/UVRI and LSHTM Uganda Research Unit, Kampala, Uganda; 8London School of Hygiene and Tropical Medicine, London, UK; 9Makerere University Lung Institute, Kampala, Uganda; 10Department of Physiology, Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda; 11Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; 12Department of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Coral Gables, FL, USACorrespondence: Rebecca Ingenhoff, Email Rebecca.ingenhoff@charite.deBackground: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally. The burden of COPD is expected to increase in low- and middle-income countries (LMICs). COPD screening and diagnostics tools are often inaccessible in rural settings of LMICs. To contribute to the growing body of evidence on the effectiveness of Community Health Worker (CHW) interventions, this study aims to understand the facilitators and barriers of implementing a CHW-led COPD screening and referral program in rural Uganda.Methods: This qualitative study was conducted from September to October 2022 to explore Community Members, CHWs, and Healthcare Providers (HCPs) perceptions on the challenges of CHW-delivered COPD programming in Nakaseke, rural Uganda. In total, we held eight individual in-depth interviews with CHWs, ten in-depth interviews with HCPs and six focus group discussions with 34 Community Members. Research assistants audio-recorded and transcribed interviews verbatim. The implementation outcomes framework guided the thematic analysis.Results: Implementation acceptability was constrained by a lack of COPD awareness, a lack of perceived utility in COPD screening as well as stigma around the diagnostic process. Limited spirometry adoption was also attributed to Community Member accessibility and willingness to participate in the COPD diagnostic referral process. The high patient volume and the complex, time-consuming diagnostic and referral process hindered successful implementation. To enhance program sustainability, all participants suggested increasing CHW support, medication access, decentralizing COPD care and upscaling follow-up of Community Members by CHWs.Conclusion: CHW-led interventions remain a potentially critical tool to alleviate barriers to treatment and self-management in settings where access to care is limited. While community-based interventions can create sustainable infrastructure to improve health outcomes, formative assessments of the potential barriers prior to intervention are required. Evidence-based, localized approaches and sustained funding are imperative to achieve this.Keywords: community health workers, task shifting, screening and referral, chronic obstructive pulmonary disease, Uganda