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.
Barriers
Facilitators
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