Table 3.

Context, Barriers, Facilitators and Implementation Strategies for a Home-based Contact Investigation Intervention Amongst Health Extension Workers in Ethiopia

Overall Context	• Ethiopia remains a high TB burden country and has poor TPT coverage among children • TB care and prevention services have largely been facility-based in Ethiopia • Time, cost of transportation, lost wages, poor quality roads, and long distances to health facilities are significant barriers to families seeking TPT for their children • The perception of medication as “treatment” in an otherwise healthy child is a significant barrier to uptake and completion of TPT • Ethiopia has a cadre of healthcare workers, called health extension workers, that provide home-based and community-based services that aim to enhance access to health promotion, disease prevention and selective treatment services that have significantly contributed to reducing child mortality over the last 20 years
Home-based contact investigation (includes contact tracing, TB evaluation, TPT initiation and TPT follow up)	Barriers and Facilitators	Implementation Strategies	Needed to support implementation
	Facilitators • Reduces caregiver burden (time, cost, etc.) • Reduced waiting time and clinic congestion • Home-based contact investigation will increase identification of household contacts • Home-based programming elevates importance of TPT in individual households and in the community • Reduced transmission of communicable illness in the health center (TB, COVID-19 etc.)	1. Task-sharing contact investigation and TPT management among HEW and TB focal person 2. Service integration to offset increased HEW workload 3. Community awareness campaigns to improve family-level acceptability of intervention and TPT	• Education on TB infection & TPT for HCWs, caregivers and community • Training on intervention protocols and implementation to HEWs, TB focal persons, pharmacists, etc • Supportive supervision of HEWs to ensure fidelity to intervention and maintenance of clinical sills • HEW medical record for family folder • Clinical support tools to assist with decision making • Registration book • Referral papers • Portable scale • Personal protective equipment • Transport for HCWs • Drug forecasting and ordering
	Barriers • Concern that necessary equipment for adequate contact investigation will not be available in the household • HEWs lack transportation or adequate reimbursement to make home visits in rural areas • HCWs lack transportation for supervising HEWs in community • Overworked, understaffed health extension program • Perceived poor motivation and commitment of HEWs • Home-visits are potentially stigmatizing • Increased access to TPT may result in drug stock outs