Barriers and facilitators to implementing an integrated electronic health records system to improve tuberculosis preventive treatment among people living with HIV: a content analysis study from Georgia

Introduction The integration of tuberculosis (TB) preventive treatment (TPT) into HIV services through electronic health records (EHR) can improve outcomes by enhancing care coordination, reducing redundancies, and supporting data-driven decision-making. In Georgia, despite close collaboration between TB and HIV programs, service delivery and data systems remain siloed, forcing patients to navigate between facilities and limiting the effectiveness of TPT among people living with HIV (PWH). Methods We conducted a qualitative study guided by the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews with 20 healthcare workers of diverse backgrounds were analyzed using deductive content analysis, structured around the five CFIR domains. The study explored the barriers and facilitators to implementing an integrated EHR system for TB and HIV programs in Georgia, with a focus on improving TPT delivery. Findings aim to inform strategies to enhance digital infrastructure and reduce TB burden among PWH. Results Participants identified several facilitators, including the perceived advantage of integrated EHR for care continuity among PWH, enhanced patient monitoring, and alignment with international donor priorities. Key barriers included concerns over confidentiality and HIV-related stigma, legal constraints, limited financial and human resources, and insufficient infrastructure such as outdated equipment and unreliable connectivity. Workforce-related challenges, including digital literacy gaps among older clinicians and increased workload during system transition, were also noted. Respondents emphasized the need for phased implementation, stakeholder engagement, and tailored training to support adoption and long-term sustainability. Conclusions Strong support exists for the implementation of an integrated EHR to improve TPT among PWH in Georgia, but significant barriers must be addressed, including confidentiality, financing, governance, and training needs. Integrating TPT into HIV services, with an EHR module designed to support patient-centered pathways, could reduce many of these challenges. A phased, context-specific approach, supported by continuous feedback mechanisms, will be critical for sustainable EHR implementation.