Barriers to access and adherence to tuberculosis services, as perceived by patients: A qualitative study in Mozambique

Abstract

Introduction Tuberculosis (TB) continues to be a leading cause of death in Sub-Saharan Africa, including Mozambique. While diagnostic methods and total notifications are improving, significant gaps remain between total numbers of TB cases annually, and the number that are notified. The purpose of this study was to elicit Mozambican patients with drug sensitive TB (DS-TB), TB/HIV and Multi drug resistant tuberculosis (MDR-TB) understanding and assessment of the quality of care for DS-TB, HIV/TB and MDR-TB services in Mozambique, along with challenges to effectively preventing, diagnosing and treating TB. Materials and methods Qualitative data was collected via separate focus group discussions consisting of patients with DS-TB, TB/HIV and MDR-TB at four health centers in Sofala and Manica Province, Mozambique, to describe knowledge on TB, HIV and MDR-TB, and identify barriers to access and adherence to services and their recommendations for improvement. A total of 51 patients participated in 11 discussions. Content analysis was done and main themes were identified. Results Focus groups shared a number of prominent themes. Respondents identified numerous challenges including delays in diagnosis, stigma related with diagnosis and treatment, long waits at health facilities, the absence of nutritional support for patients with TB, the absence of a comprehensive psychosocial support program, and the lack of overall knowledge about TB or multi drug resistant TB in the community. Discussion TB patients in central Mozambique identified many challenges to effectively preventing, diagnosing and treating tuberculosis. Awareness strengthening in the community, continuous quality monitoring and in-service training is needed to increase screening, diagnosis and treatment for TB, HIV/TB and MDR-TB.

Where are patients missed in the tuberculosis diagnostic cascade? A prospective cohort study in Ghana

“…TB-related stigma was independently associated with non-submission of sputum, consistent with findings from a study in India [22]. Several studies have reported high perception of TB-associated stigma [23][24][25][26][27], and specific actions are needed to counter this [28,29].…”

‘They are inconveniencing us’ - exploring how gaps in patient education and patient centred approaches interfere with TB treatment adherence: perspectives from patients and clinicians in the Free State Province, South Africa

“…It appears that the needs of the clinician during the consultation, described as efficiently relaying information on TB treatment and adherence, were met. However, whether this information appropriately addressed the patients concerns and expectations appears only in the context of case-finding in the literature [55][56][57][58][59][60] and not on treatment outcomes in South Africa and globally. Similar findings from a previous study demonstrated that despite standardised guidelines effectively contributing to health coverage; ignoring the subjective biopsychosocial aspects of care particularly in rigid health systems resulted in 'dehumanising' the care process [25].…”

Using community health workers for facility and community based TB case finding: An evaluation in central Mozambique

“…There is also a gap between the number of people diagnosed with and the number of people notified with TB-this is referred to as pre-treatment lost to follow-up (PTFLU). [10][11][12][13][14] We hypothesized the following situations occurred in the districts where we worked: 1) a number of individuals with TB who present to health facilities are not diagnosed; 2) TB contact tracing could be optimized if Community Health Workers (CHWs) were given a role in it; 3) CHWs could identify individuals that are PTLTFU (people who are tested and have a positive laboratory test for TB, but are not subsequently informed of their results and do not begin treatment for TB) and 4) CHWs can help relink individuals that stop their anti-TB therapy or are lost to follow-up (LTFU) to care. We wanted to evaluate if interventions performed by CHWs to improve all these four weaknesses could lead to an increase in TB notifications at the district level.…”