Table 4.

Facilitators and barriers to successful LTBI treatment completion for 2015–2016, identified in interviews with staff at BridgeCare Clinic.

Social economic model level (12, 14)	Facilitators	Barriers
Intrapersonal	Absence of side effects with first line treatment The low prevalence of alcohol dependence/issues among refugee populations	Younger age of some clients Pregnancy and family planning Unknown age Unknown medical history Language barriers Low literacy levels Concern regarding side effects Long duration of treatment
Interpersonal	Strong relationships with clients
Institutional	A significant focus on client health education Nurses in central program management roles Clients assigned to a regular primary care physician Accessible and well utilized interpreter service Multipurpose contacts with clients A patient-centered approach to care Improved efficiency and accessibility of laboratory services	Lab services availability Staff and resources limitations Communications across facilities and between providers
Socio-cultural/community	Increased likelihood of refugees having personal experience with active TB patients and fearing disease consequences	Lack of familiarity with prophylactic/preventive medicine
Structural/Policy	The availability and accessibility of IGRA testing Comprehensive health care coverage for refugees (during first year in Canada) Region-wide clinical rounds specific to LTBI	Temporary nature of clinic services Lack of material incentives for treatment completion Limited staff and resources