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Acceptance of oral swabs for tuberculosis screening among healthcare workers: a qualitative study

R Codsi(1) F Saluzzo(2,3) G Russo(3) R C Wood(1) A M Olson(1) A E Shapiro(4,5) K N O'Laughlin(4) D Rao(4) D M Cirillo(3) G A Cangelosi(1)

1:Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, 98195, USA; 2:Vita-Salute San Raffaele University; 3:IRCCS San Raffaele Scientific Institute, Milan, 20132, Italy; 4:Department of Global Health, University of Washington, Seattle, WA, 98195, USA; 5:Department of Medicine, University of Washington, Seattle, WA, 98195, USA

Reliance on sputum-based assays for the diagnosis of tuberculosis (TB) presents challenges, including occupational infection risk for healthcare workers (HCWs) and the need to collect samples from a symptomatic population. Oral swab (OS) collection may help mitigate these risks and challenges. This study aims to evaluate HCWs’ perceived risks, opportunities, and barriers regarding OS use for TB screening among migrants in Italy.

Purposive sampling was used to enrol HCWs experienced with sputum and OS collection after which they were invited for an in-depth interview. Enrolment started in November of 2023 and will continue until July 2024 or until saturation among themes is reached. We adapted Hamilton’s Rapid Qualitative Analysis Methods to summarise key findings.

All HCWs interviewed so far (N=4) indicated a preference for OS over sputum to support the scaling up of TB screening in migrants. All HCWs shared perceptions that OS reduces their occupational exposure to TB, is safer to perform, effective on both symptomatic and asymptomatic migrants, and is easier to analyse, with the possibility of pooling samples. All HCWs shared that supervision is necessary to collect a high-quality sample. All HCWs emphasised the need for solutions to language barriers and educational materials for migrants. 

Preliminary results indicate that OS represents a safe tool to perform TB screening if complemented with educational resources tailored for the migrant populations.

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