EVALUACIÓN PARCIAL DE LA FIDELIDAD EN LA IMPLEMENTACIÓN DEL TRATAMIENTO PREVENTIVO DE TUBERCULOSIS EN PERSONAS QUE VIVEN CON VIH EN PARAGUAY: UN ESTUDIO DE CIENCIA DE IMPLEMENTACIÓN.

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Bibliographic Details
Title:	EVALUACIÓN PARCIAL DE LA FIDELIDAD EN LA IMPLEMENTACIÓN DEL TRATAMIENTO PREVENTIVO DE TUBERCULOSIS EN PERSONAS QUE VIVEN CON VIH EN PARAGUAY: UN ESTUDIO DE CIENCIA DE IMPLEMENTACIÓN.
Alternate Title:	PARTIAL EVALUATION OF FIDELITY IN THE IMPLEMENTATION OF TUBERCULOSIS PREVENTIVE TREATMENT IN PEOPLE LIVING WITH HIV IN PARAGUAY: AN IMPLEMENTATION SCIENCE STUDY.
Authors:	Duarte-Zoilan, Derlis¹ derliszoilan@gmail.com, Arbeláez Montoya, María Patricia¹, Benjumea-Bedoy, Dione²
Source:	Revista Peruana de Medicina Experimental y Salud Pública. 2026, Vol. 43 Issue 2, p160-170. 11p.
Abstract (English):	Objectives. To evaluate self-reported adherence to the essential components of tuberculosis preventive treatment (TPT), as an estimate of partial implementation fidelity, and to explore the moderating factors influencing its implementation in two referral services in the Central Department, Paraguay. Materials and methods. A descriptive observational mixed-methods study with a convergent parallel design (January–May 2023) was conducted in two referral centers for people living with HIV. Partial implementation fidelity was estimated through self-reported adherence to the content and frequency dimensions of TPT implementation according to the National Tuberculosis Guide. Semi-structured interviews were conducted with key stakeholders to identify barriers and facilitators. Results. 11/13 physicians and 10 key stakeholders participated. Overall TPT fidelity was low (50.0%). Adherence to content was moderate (64.2%), while adherence to frequency was low (31.3%), evidencing a gap between perceived importance and clinical practice. The awareness/education component showed the lowest performance. The main barriers were identified in the internal environment, including organizational fragmentation between TB/HIV programs, limited resources, absence of operational protocols, and communication deficiencies. At the individual level, erroneous beliefs and low self-efficacy were identified. As facilitators, national normative alignment and the willingness of stakeholders to strengthen implementation were observed. Conclusions. Low fidelity reflects mainly organizational and process failures, which highlights the need for facilitation strategies, interprogrammatic articulation, and capacity strengthening to achieve sustained implementation. [ABSTRACT FROM AUTHOR]
Abstract (Spanish):	Objetivos. Evaluar la adherencia autoinformada a los componentes esenciales del tratamiento preventivo de la tuberculosis (TPT), como estimación de fidelidad parcial de implementación, y explorar los factores moderadores que influyen en su implementación en dos servicios de referencia del Departamento Central, Paraguay. Materiales y métodos. Estudio observacional descriptivo de métodos mixtos con diseño convergente paralelo (enero–mayo de 2023) en dos centros de referencia para personas que viven con VIH. La fidelidad parcial de implementación se estimó mediante la adherencia autoinformada a las dimensiones de contenido y frecuencia de implementación del TPT según la Guía Nacional de Tuberculosis. Se realizaron entrevistas semiestructuradas a actores clave para identificar barreras y facilitadores. Resultados. Participaron 11/13 médicos y 10 actores clave. La fidelidad global del TPT fue baja (50,0%). La adherencia al contenido fue moderada (64,2%), mientras que la adherencia a la frecuencia fue baja (31,3%), evidenciando una brecha entre la importancia percibida y la práctica clínica. El componente de sensibilización/educación presentó el menor desempeño. Las principales barreras se ubicaron en el entorno interno, incluyendo fragmentación organizacional entre los programas de TB/VIH, recursos limitados, ausencia de protocolos operativos y deficiencias en comunicación. A nivel individual, se identificaron creencias erróneas y baja autoeficacia. Como facilitadores, se observó alineamiento normativo nacional y disposición de los actores para fortalecer la implementación. Conclusiones. La baja fidelidad refleja fallas principalmente organizacionales y de proceso, lo que resalta la necesidad de estrategias de facilitación, articulación interprogramática y fortalecimiento de capacidades para lograr una implementación sostenida. [ABSTRACT FROM AUTHOR]
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Database:	MedicLatina

Description
Abstract:	Objectives. To evaluate self-reported adherence to the essential components of tuberculosis preventive treatment (TPT), as an estimate of partial implementation fidelity, and to explore the moderating factors influencing its implementation in two referral services in the Central Department, Paraguay. Materials and methods. A descriptive observational mixed-methods study with a convergent parallel design (January–May 2023) was conducted in two referral centers for people living with HIV. Partial implementation fidelity was estimated through self-reported adherence to the content and frequency dimensions of TPT implementation according to the National Tuberculosis Guide. Semi-structured interviews were conducted with key stakeholders to identify barriers and facilitators. Results. 11/13 physicians and 10 key stakeholders participated. Overall TPT fidelity was low (50.0%). Adherence to content was moderate (64.2%), while adherence to frequency was low (31.3%), evidencing a gap between perceived importance and clinical practice. The awareness/education component showed the lowest performance. The main barriers were identified in the internal environment, including organizational fragmentation between TB/HIV programs, limited resources, absence of operational protocols, and communication deficiencies. At the individual level, erroneous beliefs and low self-efficacy were identified. As facilitators, national normative alignment and the willingness of stakeholders to strengthen implementation were observed. Conclusions. Low fidelity reflects mainly organizational and process failures, which highlights the need for facilitation strategies, interprogrammatic articulation, and capacity strengthening to achieve sustained implementation. [ABSTRACT FROM AUTHOR]
ISSN:	17264634
DOI:	10.17843/rpmesp.2026.432.15170