‘Involve those who are managing these outbreaks’: stakeholders’ perspectives on the barriers and facilitators to the implementation of clinical management guidelines for high-consequence infectious diseases in Uganda—a thematic network analysis

Kabajaasi, Olive, Schilling, Stefan, Akugizibwe, Mathias, Horby, Peter W, Hart, Peter, Sigfrid, Louise and Jacob, Shevin ORCID: https://orcid.org/0000-0003-2425-9394 (2025) '‘Involve those who are managing these outbreaks’: stakeholders’ perspectives on the barriers and facilitators to the implementation of clinical management guidelines for high-consequence infectious diseases in Uganda—a thematic network analysis'. BMJ Public Health, Vol 3, Issue 1, e001165.

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Abstract

Introduction. Prior research highlighting the complexity of clinical management guidelines’ (CMGs) implementation during high consequence infectious disease (HCID) outbreaks has suggested that limited access to treatments and equipment and substantial issues regarding availability, inclusivity, quality and applicability hinders the implementation of CMGs in low- and middle-income countries (LMICs). This in-depth case study of Uganda—coincidentally occurring during the 2022 Sudan virus disease outbreak—aimed to explore contextual and supplementary factors which hinder or facilitate CMG development and implementation.

Methods. Between August and December 2022, 43 interviews were conducted with medical personnel, consultant physicians, case managers and Uganda Ministry of Health officials. Interviews were analysed using a thematic network analysis approach to visualise thematic codes in qualitative data and highlight inherent relationships between codes.

Results. Six thematic topics emerged as the main barriers to the implementation of CMGs during HCID outbreaks in Uganda: (1) deficient content and slow updates of CMGs; (2) scarce resources and healthcare disparities; (3) slow dissemination and limited access to guidelines; (4) improvisation of patient care (5) lack of training for healthcare workers (HCWs); and (6) limited pandemic preparedness and response infrastructure. Codes most strongly linked to facilitators and suggestions included: (1) HCW training in CMG implementation; (2) adequate resourcing; (3) involvement of personnel with prior HCID response experience in CMG development and (4) improvements in access to CMGs.

Conclusions. By illustrating linkages to resource constraints, healthcare disparities, and limited surveillance and referral infrastructure, our study displays how insufficient training, patchy dissemination and slow updating exacerbate many of the underlying difficulties for CMG implementation in LMIC contexts. Findings offer valuable insights for LMICs to improve HCID outbreak responses and inform implementation of CMGs in future HCID outbreaks, where evidence is often initially limited. Recommendations to enhance CMG implementation are provided.

Item Type:	Article
Subjects:	WA Public Health > Preventive Medicine > WA 110 Prevention and control of communicable diseases. Transmission of infectious diseases WA Public Health > WA 30 Socioeconomic factors in public health (General)
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1136/bmjph-2024-001165
SWORD Depositor:	JISC Pubrouter
Depositing User:	JISC Pubrouter
Date Deposited:	13 Mar 2025 12:47
Last Modified:	13 Mar 2025 12:47
URI:	https://archive.lstmed.ac.uk/id/eprint/26189

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