Enablers and barriers to stool sample collection for TB diagnosis: insights from caregivers and adult patients in three high TB/HIV burden countries in Sub-Saharan Africa (Eswatini, Mozambique, and Uganda)

Résumé fourni par la source

New stool-based TB diagnostics, such as Xpert Ultra, have shown promise in improving TB diagnosis in children and people living with HIV. However, limited research has explored the acceptability of stool collection among these target groups. This study aimed to assess the barriers and enablers influencing the willingness of caregivers of minor patients and adults to provide stool samples for TB diagnosis. We employed a generic qualitative study design that integrated different data collection approaches, including exit-, in-depth, and semi-structured interviews. This study was conducted in Eswatini, Mozambique, and Uganda between February 2022 and October 2024. A total of 102 participants, comprising 79 caregivers and 23 adult living with HIV, were recruited. Most participants reported no prior experience with stool sample collection. Nonetheless, they reported minimal difficulties in collecting stool samples and expressed a high willingness to provide stool samples. Factors influencing this willingness included the desire to recover from illness, trust in the healthcare system, and the non-invasive nature of the procedure. Refusals were rare, reported in 2 out of 102 participants. These were mainly attributed to challenges in obtaining stool samples at the required time and discomfort with handling the samples. Additionally, factors such as transportation costs to the health facility, direct association between sputum and cough, local beliefs surrounding stool were identified as potential barriers that may reduce willingness and shape patients’ preference for sputum-based methods over stool-based approaches, even among those otherwise open to providing stool samples. Our findings revealed that, despite high willingness among our participants to provide stool samples, several barriers could influence the acceptability of Sb-TBD and preference for alternative TB diagnostic procedures. These challenges should be addressed through strategies such as providing clear instructions for stool sample collection with collection kits, alongside community-based interventions to improve awareness and understanding of Sb-TBD. This study is part of the Stool4TB study, registered on 2021-09-08 under ID NCT05047315 on https://www.clinicaltrials.gov/.

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