Outreach—lack of patient tracking and follow-up35 42 50

Referrals from clinics or private facilities to DRTB care centres not done42 43 50

Poor HCW information or knowledge of TB, resistance, guidelines or algorithms31 35 39–41 46 67

Lack of guideline knowledge and adherence28 31 34 42

Poor knowledge of disease and perceptions of service31 32 40

Distrust and unmet expectations31 32

Raise public awareness of symptoms and the need for early care32 40

Improve HCW knowledge/training and supervision on TB surveillance, resistance monitoring, guidelines and algorithms.27 29 31 39 41 42 44 46 47 53

Improve surveillance, data management, referral and screening, eg, intensified case finding, appointment of dedicated linkage officers in each district.28 30 32 34 35 39 41 43 44 46 47 50 51

Increase access to newer, rapid diagnostics point-of-care Xpert and ensure proper deployment and use.7 36 38 41 44 49 51–53 67

Use of home visits or alert systems to follow-up patients35 40–42

Broad-based policies and strategies to improve screening41 47 51

Professional values, norms and attitude45

Care attributes—infection control, long duration of hospitalisation/treatment40 45

Personal and social values32 36

Disclosure and confidentiality31 45

Culture and gender norms32

Work and family commitments32

Patient sociodemographic characteristic, treatment history and comorbidities27 30 33 39 43 44 50 51

Choosing alternative care32

Fear of infection, delays or side effects29 32 40

Improve service delivery including integration and retention in care, eg, appointment of linkage officers in each district.2 4 6 20

Reduce hospitalisation duration45

- Strengthen infection control measures and occupational health services.29 31 40 45

Increase home-based care of DR-TB42 45

Improve visitation policies for hospitalised patients45

More attention to patient-level barriers.29 33

Bed spaces for hospitalisation phase51

Health products: inadequate supplies of diagnostics and drugs67

Personnel: shortages in HCW quantity and quality45 47

Laboratory and clinic operational errors and delays27 28 31 34 37 47 51 53 54

Inadequate access to or low utilisation of newer diagnostic instruments7 27 32 35 38 49 52 54 67

Regional operational differences27 33

Poor sputum specimen27

Difficult transportation to facility37 39 40 49

Lack of social support45

Geographic located far from care27 33 37 40 50 51

Outmigration or death36 42

Decentralising, linking and integrating services7 33 37 40 41 51

Improve social and psychosocial support45

Increase HCW quantity and quality.47

Enable same day treatment initiation after Xpert37

Two sputum specimen at baseline27

Increase capacity and quality of inpatient and community-based care51

Ensuring continuous supply of health products.49

Expanded and timely access to treatment regimens, facilities and strategies.8 21 23

Programme structure29 32 40

Lack of funding for sputum transportation and consumables²⁸

Inability to pay for transport or treatment requirements; opportunity costs40

Increased government investment28