Research Article

Listening to Those at the Frontline: Patient and Healthcare Personnel Perspectives on Tuberculosis Treatment Barriers and Facilitators in High TB Burden Regions of Argentina

Table 1

Barriers to and facilitators of successful completion of treatment by category.

BarriersFacilitators

Individual-Drug side effects (e.g., GI upset, bitter taste)
-Lack of TB knowledge about the disease and treatment
-Fear related to TB (e.g., incurable, loss of work, or
discrimination)
-Interpretation of feeling better means cured
-Comorbidities (e.g., alcoholism, drug addictions)
-Personal/family challenges




-Desire to be cured, personal motivation
-Personal experience with other TB patients
-Strong patient-provider relationship
-Personal characteristics of healthcare
personnel: committed, compassionate,
supportive, able to establish trust
(builds rapport with patients and longevity
in the community and center), having
personal calling to serve others, and able to
humanize disease and situation
-Interpreting feeling better as cured

Structural/Social-Access to healthcare centers (e.g., distance, transportation
issues, and cost)
-Poverty, precarious living conditions
-Low wages for healthcare workers
-Long treatment course
-Vulnerable patient populations
-Informal employment (e.g., day labor), women with
 childcare challenges, “health tours,” with comorbidities
 (e.g., addictions, HIV/AIDS), living in poverty,
 adolescence
-Dispersed healthcare centers throughout
communities/region
-Free-of-charge medication and services for TB
treatment
-Social support of family and friends,
healthcare personnel, volunteer community
health promoters



-Discrimination and/or stigmatization
-Lack of education in communities and schools leading to poor
TB awareness and understanding of treatment
-Perception of low quality of care offered at healthcare center
-Instability of political commitment/support
-Financial subsidy delays and low rates of application
 due to inadequate dissemination and clarity
 of policy/regulations
-Reassigning positions/frequent staff turnover
-Lack of official recognition and monetary
 compensation of TB positions

Organization/System/Health Service-Resistance to use directly observed therapy (DOT) by some
healthcare personnel
-DOT
-Self-administration standard at hospitals (conflicting messages
to patients)
-Self-administration offered first
-Low index of suspicion of TB resulting in diagnostic delays
-Underutilization of decentralized healthcare system
-Lack of collaboration/referrals between hospital and
 healthcare centers
-Cases concentrated for treatment at hospital level
-Lower treatment success and high rates of
 abandonment at hospital level
-Disparity in size, resources, hours of service, and staff
 composition at healthcare centers
 (e.g., short on TB supplies, no computers, and lack of
 specialists or physicians)
-Overburdened staff
-Inefficiency in collection of data (outcome monitoring)
-Patients lost to follow-up, poor tracking
-Paper-based healthcare records
 (no computers at centers)
-Lack of centralized surveillance system
-Delayed and underreported case
 outcomesdelayed/incomplete program
 evaluations (up to 2 years)
-Mistrust in accuracy of reported data
-Subsidy for those who continue/complete
treatment
-Being convinced of DOT effectiveness
-DOT
-Decentralized healthcare system
-Healthcare centers situated at about every
 10–15 blocks
-Facilitating healthcare center characteristics
(limited implementation)
-Open 24 hours
-Provision of DOT without appointment
 and through separate door
 (not having to wait in waiting room)
-Use of politically appointed community
 advocates to find and return patients to
 treatment
-Medication availability (not always the case)
-Established laboratory/diagnostic network
considered reliable and available
-Continuity of healthcare personnel
-Capacity of TB healthcare team members