Providing person-centred TB care: a participatory study with healthcare workers in Nairobi, Kenya

Policies promote patient-centred tuberculosis (TB) care in Kenya, a high-burden TB country, but implementation remains limited. This study sought to understand the experiences of TB healthcare workers in implementing patient-centred TB services in primary health facilities in Nairobi and explore how the challenges they face can be addressed.

Using collaborative research design, we recruited healthcare workers (n=29) from primary health facilities across three densely populated subcounties in Nairobi and TB stakeholders (n=24) including policymakers and managers. From March to April 2024, we collected data through three workshops with nurses (n=19) and clinical officers/doctors (n=10) and a joint workshop with stakeholders. Participants engaged in group discussions and participatory visual methods to define person-centred care, document practices, identify challenges and develop solutions. Our data analysis applied a framework approach drawing on the social-ecological, TB care cascade and health systems building blocks models.

Healthcare workers identified practices for differentiated TB care across age groups, genders, occupations and comorbidities. Implementation faced multiple challenges including structural, health system, community and patient's individual constraints. Shortages of funding, workforce and capacity affected close-to-community TB screening (Theme 1). Insufficient testing capacity at lower-level facilities led to diagnostic delays (Theme 2). Inflexible clinic hours and medication stockouts requiring frequent facility visits undermined TB treatment and adherence among working populations (Theme 3). Weak collaboration and referral systems limited support for people facing homelessness, substance use or poverty. Healthcare workers proposed enhanced TB training, increased TB workforce, flexible medication delivery, integrated TB services and strengthened intersectoral collaboration with education, labour and social protection sectors (Theme 4).

Healthcare workers demonstrate willingness and capacity to deliver patient-centred TB care but require strengthened health systems, ongoing training and sustainable intersectoral partnerships. Scaling up identified practices and innovative tools while addressing systemic barriers could improve TB care delivery and outcomes for underserved populations.