Exploring Community Tuberculosis Program in the Pastoralist Setting of Ethiopia: a Qualitative Study of Community Health Workers' Perspectives in Borena Zone, Oromia Region

Abstract Background: Tuberculosis (TB) is one of the top ten causes of death and thee first cause of death due to single infectious disease in the world. Nevertheless, access to TB prevention and control is not uniform even within a country, The community TB program is designed to improve the access in Ethiopia. Exploring the program performance from the perspectives of its implemters in a pastoral setting remains important. Method: We conducted a qualitative study using an interpretive description method in the pastoralist community setting of Ethiopia. Study participants were recruited from geographically dispersed areas. Data were collected through in-depth interview using semi-structured guides and audio recordings during February 01-30, 2020. The interview guide was developed based on consultation with TB program experts and clinicians treating TB patients in the study area. Notes were taken at the interview to enrich the transcription of the data. The interview was conducted by the principal investigator. The subsequent data collection was informed by emerging ideas from forgoing interview transcriptions. The interview continued until data saturation was achieved. Results: One hundred and fisty six codes, nine categories and three themes emanated. The first theme was an inadequate community TB performance and some of its codes include inadequate presumptive TB case identification and compromised DOTs service delivery. The second theme was factors contributing to the performance. Community factors, lack of physical access to health facilities and indirect non-medical cost are some of categories under this theme. The final theme was related to solutions and its categories include a need for active community involvement and modification of service delivery approaches. Conclusion: Community TB performance is inadequate in the pastoralist community and many factors contribute to the inadequate performance. Aligning the program to the context of the pastoralist community setting is required to improve the performance.