Table 2.

Barriers and facilitators of TB contact investigation identified by study participants.

Themes & Sub-themes	Barriers	Facilitators
Healthcare operations
Data quality and inter-institutional coordination	Provider: missing or inaccurate data reported to the surveillance system impedes tracking of contacts SoPH: missing data impedes the scheduling of household visits SoPH: suboptimal local inter-institutional cooperation limits progress in solving data quality issues Contact: inadequate or missing communication between insurers impedes the uptake of TB testing.	None identified
Resource needs	SoPH: lack of specific guidelines and scripts for scheduling and household visit procedures affect scheduling success. SoPH: lack of dedicated phone lines for contact investigation-related tasks creates inconveniences for CHWs	None identified
Access to households	SoPH: missing data hinders scheduling efforts and increases the risk of visit rejection or absence of some household members SoPH: safety concerns impede access to households in some neighborhoods	SoPH: collaboration with community leaders promotes access to households in unsafe neighborhoods
Essential knowledge
General TB knowledge	Provider: lack of TB awareness by physicians causing delayed diagnosis Provider: misinformation among staff causing negative interactions with index cases Contact: low-risk perception decreased the likelihood of contacts seeking TB diagnosis Contact: misinformation about transmission within the household resulted in unnecessarily harsh preventive measures against TB cases.	Provider: index cases disseminate accurate information to their contacts, increasing test uptake Contact: seeking diagnostic behaviors was reported among those with better TB knowledge and good TB knowledge transfer interactions
Skills needs for Clinic and SoPH staff	None identified	SoPH: knowledge of the structure of the healthcare system to find or correct patient information SoPH: good communication skills increase the likelihood of acceptance of household visits and associated tasks
Time limitations and competing responsibilities
Time constraints of Clinic and SoPH staff	Provider: time limitations for physicians affect data quality SoPH: multiple job responsibilities complicate scheduling household visits	None identified
Competing demands for Contact	SoPH: C/co competing demands prevent the scheduling of household visits Contact: competing demands related to work or caring for relatives impedes TB uptake| Contact: time and effort to obtain a prescription for TB testing for contacts	None identified
Interpersonal interactions
Stigma	Provider: stigmatizing experiences with clinic staff could discourage further interaction with the clinic or SoPH staff SoPH: anticipated stigma can prevent acceptance of household visits	None identified
Trust	None identified	SoPH: continuity of CHW for scheduling and visits increased the likelihood of acceptance of household visits Contact: follow-up visits, particularly by a trusted CHW, encouraged contacts to seek TB testing

The table organizes barriers to and facilitators of the TB contact investigation process for each theme and sub-theme identified. CHW, community health workers; SoPH, Secretary of Public Health; TB, tuberculosis.