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PA-755 Feasibility and acceptability of stool-based TB diagnosis: perspectives from healthcare providers in Manhiça district, southern Mozambique
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  1. Agostinho Lima1,
  2. Helder Djive1,
  3. Otilia Cossa1,
  4. Sozinho Acacio1,
  5. Anna Mandalakas2,
  6. Alexander Kay2,
  7. Willy Ssengooba3,
  8. Christoph Lange4,
  9. Sabine Hermans5,
  10. Khatia Munguambe1,
  11. Alberto Garcia-Basteiro6
  1. 1Centro de Investigação em Saúde da Manhiça (CISM), Mozambique
  2. 2Baylor College of Medicine and Texas Children’s Hospital, USA
  3. 3Makerere University, Uganda
  4. 4Research Center Borstel, Leibniz Lung Center, Germany
  5. 5Amsterdam Institute for Global Health and Development, The Netherlands
  6. 6Institute for Global Health (ISGlobal), Spain

Abstract

Background Stool-based TB diagnostics (SbTBD) are reported to contribute to increased rates of bacteriological confirmation in children and people living with HIV. However, there is a lack of evidence on perceived feasibility and acceptability of SbTD in TB high burden countries. Within the Stool4TB project, funded by EDCTP, this study aimed to assess healthcare providers’ (HPs) perspective on the feasibility and acceptability of SbTD.

Methods A qualitative study was conducted across five health facilities and four communities within the Manhiça District (Mozambique). Twenty-one semi-structured interviews were conducted with HPs, from February 2022 to March 2023. The interviews were transcribed, coded, entered in a matrix and analyzed using the Diffusion of Innovation and symbolic power theories.

Results According to HPs, the SbTD can be suitable for diagnosis of TB in people who have difficulty in producing sputum, especially children; the approach is considered simple, non-traumatic, and feasible supporting sample capture across all age groups. However, according to respondents, the acceptability of this technique might vary among the patients. Refusals might be due to delays in receiving assistance; lack of awareness about the technique; fear and disgust of touching stool; the association of stool with witchcraft and local beliefs about TB transmission. On the other hand, acceptability could depend on: feeling obliged to comply with government recommendations; the good experience with health services, and the expectation of being cured.

Conclusion HPs view Stool-based TB diagnostics as a more advantageous approach in terms of feasibility compared to other diagnostic strategies, such as sputum-based approaches. However, patient acceptability may be compromised due to existing health services challenges and perceptions about stool and TB. Acceptability could be promoted by the dissemination of information about the SbTD, enforcement of awareness raising about TB and SbTD, and increasing experience and trust in the health services.

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