Understanding barriers to tuberculosis diagnosis and treatment completion in a low-resource setting: A mixed-methods study in the Kingdom of Lesotho.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2023
2023
Historique:
received:
24
10
2022
accepted:
28
04
2023
medline:
15
5
2023
pubmed:
11
5
2023
entrez:
11
5
2023
Statut:
epublish
Résumé
Lesotho is one of the 30 countries with the highest tuberculosis incidence rates in the world, estimated at 650 per 100,000 population. Tuberculosis case detection is extremely low, particularly with the rapid spread of COVID-19, dropping from an estimated 51% in 2020 to 33% in 2021. The aim of this study is to understand the barriers to tuberculosis diagnosis and treatment completion. We used a convergent mixed methods study design. We collected data on the number of clients reporting symptoms upon tuberculosis screening, their sputum test results, the number of clients diagnosed, and the number of clients who started treatment from one district hospital and one health center in Berea district, Lesotho. We conducted in-depth interviews and focus group discussions with 53 health workers and patients. We used a content analysis approach to analyze qualitative data and integrated quantitative and qualitative findings in a joint display. During March-August, 2019, 218 clients at the hospital and 292 clients at the health center reported tuberculosis symptoms. The full diagnostic testing process was completed for 66% of clients at the hospital and 68% at the health center. Among clients who initiated tuberculosis treatment, 68% (61/90) at the hospital and 74% (32/43) at the health center completed treatment. The main barriers to testing and treatment completion were challenges at sample collection, lack of decentralized diagnostic services, and socioeconomic factors such as food insecurity and high patient movement to search for jobs. Tuberculosis diagnosis could be improved through the effective decentralization of laboratory services at the health facility level, and treatment completion could be improved by providing food and other forms of social support to patients.
Sections du résumé
BACKGROUND
Lesotho is one of the 30 countries with the highest tuberculosis incidence rates in the world, estimated at 650 per 100,000 population. Tuberculosis case detection is extremely low, particularly with the rapid spread of COVID-19, dropping from an estimated 51% in 2020 to 33% in 2021. The aim of this study is to understand the barriers to tuberculosis diagnosis and treatment completion.
METHODS
We used a convergent mixed methods study design. We collected data on the number of clients reporting symptoms upon tuberculosis screening, their sputum test results, the number of clients diagnosed, and the number of clients who started treatment from one district hospital and one health center in Berea district, Lesotho. We conducted in-depth interviews and focus group discussions with 53 health workers and patients. We used a content analysis approach to analyze qualitative data and integrated quantitative and qualitative findings in a joint display.
FINDINGS
During March-August, 2019, 218 clients at the hospital and 292 clients at the health center reported tuberculosis symptoms. The full diagnostic testing process was completed for 66% of clients at the hospital and 68% at the health center. Among clients who initiated tuberculosis treatment, 68% (61/90) at the hospital and 74% (32/43) at the health center completed treatment. The main barriers to testing and treatment completion were challenges at sample collection, lack of decentralized diagnostic services, and socioeconomic factors such as food insecurity and high patient movement to search for jobs.
CONCLUSIONS
Tuberculosis diagnosis could be improved through the effective decentralization of laboratory services at the health facility level, and treatment completion could be improved by providing food and other forms of social support to patients.
Identifiants
pubmed: 37167298
doi: 10.1371/journal.pone.0285774
pii: PONE-D-22-29321
pmc: PMC10174523
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0285774Informations de copyright
Copyright: © 2023 Andom et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
PLoS Med. 2016 Oct 25;13(10):e1002149
pubmed: 27780217
PLoS Med. 2019 Feb 27;16(2):e1002754
pubmed: 30811385
PLOS Glob Public Health. 2022 Mar 16;2(3):e0000249
pubmed: 36962295
Lancet. 2015 Dec 5;386(10010):2334-43
pubmed: 26515675
J Glob Health. 2019 Jun;9(1):010423
pubmed: 31263546
BMC Public Health. 2008 Jan 11;8:11
pubmed: 18186946
Eur Respir J. 2014 Jun;43(6):1763-75
pubmed: 24525439
BMC Health Serv Res. 2022 Jun 28;22(1):831
pubmed: 35764982
BMC Public Health. 2010 Oct 28;10:651
pubmed: 21029405
BMC Public Health. 2010 Mar 30;10:173
pubmed: 20353567
Bull World Health Organ. 2018 Jul 01;96(7):471-483
pubmed: 29962550
Tuberc Res Treat. 2016;2016:2036234
pubmed: 27066271
PLoS One. 2020 Jun 3;15(6):e0233620
pubmed: 32492022
Lancet. 2014 Sep 13;384(9947):1005-70
pubmed: 25059949
Int J Environ Res Public Health. 2022 Jan 31;19(3):
pubmed: 35162643
J Infect Dis. 2017 Nov 6;216(suppl_7):S702-S713
pubmed: 29117342
Qual Health Res. 2005 Nov;15(9):1277-88
pubmed: 16204405
Int J Tuberc Lung Dis. 2018 Oct 1;22(10):1152-1159
pubmed: 30236182
Lancet. 2010 May 22;375(9728):1814-29
pubmed: 20488524
PLoS One. 2020 Jan 15;15(1):e0227293
pubmed: 31940375
Soc Sci Med. 1997 Feb;44(3):347-58
pubmed: 9004369
Cad Saude Publica. 2018 Feb 05;34(1):e00153116
pubmed: 29412320
Int Health. 2014 Sep;6(3):181-8
pubmed: 25100402
PLoS One. 2015 Sep 29;10(9):e0138413
pubmed: 26418678
Ann Fam Med. 2015 Nov;13(6):554-61
pubmed: 26553895