Background:Tuberculosis(TB)is a major global health threat and the leading infectious disease cause of death worldwide.Access to and retention in TB care remains a challenge for patients,particularly those living in r...Background:Tuberculosis(TB)is a major global health threat and the leading infectious disease cause of death worldwide.Access to and retention in TB care remains a challenge for patients,particularly those living in rural and remote settings.This qualitative study explored barriers and facilitators to accessing and maintaining contact with TB care services in communities in Xigaze(Shigatse)prefecture,Xizang Autonomous Region(Tibet Autonomous Region),China from the perspective of persons impacted by TB.Methods:We conduced in-depth interviews with 23 participants impacted by TB in four rural districts in Xigaze prefecture,Xizang Autonomous Region,China between April 2019 and November 2020.Interviews were conducted in Tibetan and Mandarin,transcribed in Mandarin and translated into English.Transcripts were checked against recordings by native Tibetan and Mandarin speakers.QSR NVivo12 software was used for framework analysis guided by an access to care conceptual framework by Levesque et al.Results:Overall patients reported low awareness of and an indiferent attitude towards TB,although all reported understanding the need to adhere to treatment.Participants reported complex pathways to care,often requiring visits to multiple healthcare facilities.Some participants reported visiting traditional Tibetan medicine(TTM)providers.Participants reported various barriers to accessing care including challenges physically reaching care,out-of-pocket payments for tests,diagnostics and transport.Barriers to maintaining care included medication side efects and worry about treatment efectiveness.Enablers to accessing care identifed included knowledge or past experience with TB,integrated models of TTM and western care,supportive village doctors who conducted home visits,free TB treatment and other subsidies,as well as having family support with care and social support as barriers and facilitators to maintaining treatment.Conclusions:We identifed barriers and facilitators to accessing services in rural communities in Xigaze from the perspective of persons impacted by TB.Challenges include complex pathways to care,travel distances,wait times and low awareness.Tuberculosis care in the region could be strengthened by ongoing culturally tailored educational campaigns to increase awareness,partnerships with TTM providers,providing comprehensive treatment subsidies and strengthening the role of family members in comprehensive TB care.展开更多
基金funded by TB REACH,a special initiative of Stop TB Partnership(Grant Number:STBP/TBREACH/GSA/W6–5).
文摘Background:Tuberculosis(TB)is a major global health threat and the leading infectious disease cause of death worldwide.Access to and retention in TB care remains a challenge for patients,particularly those living in rural and remote settings.This qualitative study explored barriers and facilitators to accessing and maintaining contact with TB care services in communities in Xigaze(Shigatse)prefecture,Xizang Autonomous Region(Tibet Autonomous Region),China from the perspective of persons impacted by TB.Methods:We conduced in-depth interviews with 23 participants impacted by TB in four rural districts in Xigaze prefecture,Xizang Autonomous Region,China between April 2019 and November 2020.Interviews were conducted in Tibetan and Mandarin,transcribed in Mandarin and translated into English.Transcripts were checked against recordings by native Tibetan and Mandarin speakers.QSR NVivo12 software was used for framework analysis guided by an access to care conceptual framework by Levesque et al.Results:Overall patients reported low awareness of and an indiferent attitude towards TB,although all reported understanding the need to adhere to treatment.Participants reported complex pathways to care,often requiring visits to multiple healthcare facilities.Some participants reported visiting traditional Tibetan medicine(TTM)providers.Participants reported various barriers to accessing care including challenges physically reaching care,out-of-pocket payments for tests,diagnostics and transport.Barriers to maintaining care included medication side efects and worry about treatment efectiveness.Enablers to accessing care identifed included knowledge or past experience with TB,integrated models of TTM and western care,supportive village doctors who conducted home visits,free TB treatment and other subsidies,as well as having family support with care and social support as barriers and facilitators to maintaining treatment.Conclusions:We identifed barriers and facilitators to accessing services in rural communities in Xigaze from the perspective of persons impacted by TB.Challenges include complex pathways to care,travel distances,wait times and low awareness.Tuberculosis care in the region could be strengthened by ongoing culturally tailored educational campaigns to increase awareness,partnerships with TTM providers,providing comprehensive treatment subsidies and strengthening the role of family members in comprehensive TB care.
