A thorough perusal of the literature shows that this is the first study to assess knowledge, attitude, and practice (KAP) on IPT and the associated factors among healthcare workers in Tanzania. The findings suggest a complex coherence of knowledge, attitude, and practice parameters. The low level of adequate knowledge and positive attitude among healthcare workers implies a potential gap in their understanding of IPT, which could impact the effectiveness of preventive measures to be implemented. It may further indicate a lack of enthusiasm or reluctance among health workers, which could affect their engagement in IPT services. However, the observed good practice suggests that despite the challenges in knowledge and attitude, the majority of healthcare workers were effectively implementing IPT.
In the current study, less than half of the healthcare workers had adequate knowledge of IPT. Our findings are similar to the studies done in Indonesia, and South Africa which found that 30.6% and 43.1% had adequate knowledge of IPT, respectively(13, 18–20). However, studies conducted in Nigeria and Ethiopia found a higher level of adequate knowledge of IPT among healthcare workers above 50% (12, 21, 22). Having less than half of healthcare workers with adequate knowledge of IPT may lead to suboptimal implementation, compromised patient care, and an increased risk of preventable health issues in the community. Healthcare workers must undergo retraining to guarantee that they are all well-versed in IPT. The program implementers might also need to come up with better strategies for delivering training including conducting a pre-assessment of training needs and identifying areas in which HCWs require additional knowledge.
Our study revealed that 47.0% of the healthcare workers had a positive attitude towards IPT. These results are different from the study conducted in Indonesia, South Africa, India, and Australia which found a positive attitude of above 50% (13, 18, 22–24). The presence of fewer healthcare workers with positive attitudes may be attributed to limited awareness and education about IPT and challenges in healthcare infrastructure. In the current study, a noteworthy percentage of healthcare workers (90.9%) demonstrated good practices in IPT services. This might have been influenced by the presence of clear guidelines and IPT circulars focused on increasing IPT service uptake. This finding implies overwhelming efforts to improve IPT coverage forgetting the core aspects of training to incentivise HCW towards well-informed and technical decision-making in IPT service delivery.
Healthcare workers who were aged 40 years and above were 76% more likely to have adequate knowledge of IPT compared to those aged below 40 years indicating a potential correlation between age and knowledge. This suggests the need for targeted educational efforts among younger healthcare professionals to improve their knowledge of IPT. However, the current results are different from those observed in an earlier study done in Ebonyi State, Nigeria which they found that ages 35 years and below were more likely to have adequate knowledge of IPT (12). The difference can be attributed to the fact that the earlier study was done in one state and had a sample size of 85 healthcare workers, unlike the current study.
University education was found to be a significant factor in adequate knowledge of IPT among healthcare workers. Healthcare workers with a University education were 4.48 times more likely to have adequate knowledge of IPT compared to those with secondary education. The finding was supported by a study conducted in Pune, India (25). This suggests that healthcare workers with a university education have a more in-depth and specialized curriculum at the university level, exposure to advanced training, and a higher likelihood of engaging in continuous professional development (26). A mentorship program should be emphasized to improve IPT knowledge among healthcare workers who do not have a university education. Those who ever attended IPT training were 98% more likely to have adequate knowledge of IPT. These results are similar to the study conducted in South Africa and Brazil (13, 27). Suggesting that continuous training should be offered to healthcare workers regularly to improve their knowledge of IPT.
The likelihood of female HCWs’ positive attitude toward IPT compared to their male counterparts suggests a need to emphasize targeted interventions and awareness campaigns to address gender disparities among HCWs which may influence their attitude towards preventive therapies. Those who had a working experience of more than one year at TB/HIV clinics were 5.20 times more likely to have good practices on IPT. These results are similar to the study conducted in Indonesia (18). This might have been influenced by the availability of circulars at hand in health facilities.
Limitations
The inability of some healthcare workers to participate due to their busy hospital schedules resulted in a reduction of the sample size from 486 to 464 participants. Additionally, the study's scope was confined to healthcare facilities in 12 regions supported by global funds, representing various levels of healthcare facilities. Therefore, caution should be exercised when generalizing the findings to the entire country, as the study may have not fully captured the diversity of healthcare settings and practices across Tanzania.