1372. Patient’s Perceptions of Barriers to Tuberculosis Care in Private Sector in India

Abstract

BackgroundIn spite of ambitious plans of all the stakeholders involved there is still a long way to go before Tuberculosis (TB) is eliminated In India due to barriers to care and cure. About half of the population affected with TB gets treated in the private sectors. This study was aimed to assess the patient knowledge on Tuberculosis and identify the barriers perceived by them.MethodsA prospective study was conducted in a tertiary care center for a period of 3 months after obtaining approval from the Institutional ethics committee. All adults >18years diagnosed with tuberculosis (pulmonary, extrapulmonary) and receiving treatment in the Infectious Diseases Department were included. Subjects enrolled in the study were fully informed and gave their consent. A questionnaire was used to gather data regarding patient demographics, location, household size, co-morbid conditions, treatment, adverse drug reactions and barriers faced for their treatment.ResultsA total of 50 patients enrolled in the study. The majority of subjects belonged to age groups of 31–50 years (38%) with postgraduates accounting for 30%. About half (48%) of them were not working and 36 (72%) were married. About 31 (62%) were residing locally. The household size was 3–5 members (72%). Diabetes (13, 26%) and hypertension (11, 22%) were the common comorbid conditions seen. Newly diagnosed cases comprised of 35 (70%). Extrapulmonary TB was seen in 30 cases (60%) with lymph node and spine TB being more common. Adherence to the treatment was seen in 34(68%). Awareness regarding treatment duration and importance of treatment completion was seen in 64% and 82% of the study population, respectively. About 62% had visited more than one doctor for diagnosis with 42% responded that there was a delay in diagnosis. Common Barriers faced were stigma, adverse drug reactions, and transportation in 40 %, 12%, and 6% cases. The other factors faced by the respondents were the cost of diagnosis and treatment, adherence issues and loss of income.ConclusionIndia has the world’s highest incidence of Tuberculosis. Multifaceted barriers worsen the burden of Tuberculosis. Private sectors treat the majority of the extrapulmonary disease. Intensified efforts by means of public awareness and education are required to prevent the delay in diagnosis and reducing stigma. Disclosures All authors: No reported disclosures.

Contributing Factors in the Tuberculosis Care Cascade in India: A Systematic Literature Review

“…Other personal factors that remained are fear of diagnosis, fear of the outcome measures, fear of loss of occupation, fear of society, 19 , 27 etc. Focusing on the individual factors with more specific to TB treatment, factors like the inability to collect the medicine, 17 travel-related (transportation, cost), 18 , 31 self-withdrawal once the symptoms subside, 18 , 19 inability to produce sputum, 20 past unpleasant experience of DOT, 20 multiple visits/consultation of health-care providers, 23 , 32 delays in approaching provider after leaving a previous provider, 10 , 26 , 35 delays in getting the test done and collecting results, self-refusal to get the test done, 10 , 26 dissatisfied with services, 40 cost of diagnosis and treatment 38 etc. remained contributing factors towards the outcome of the TB care cascade.…”

“…remained contributing factors towards the outcome of the TB care cascade. In addition to it, some of the factors specific to the TB drugs also narrated in some of the studies, among others high pill burden, 17 adverse drug and treatment effects, 38 long duration of therapy 17 , 18 remained as the generic concern of the TB patients.…”

“…Some of the social factors, which are more context-specific, should be addressed to improve the TB cascade and other public health challenges. Factors like stigma, 19 , 20 , 38 discrimination, 20 lack of family to the social support, 27 , 29 , 32 negative counselling by family/friends 10 also contribute largely to the care cascade. Table 2 summarizes all the factors (both system-side and demand-side) as evidenced in the synthesis contributing to the care cascade.…”

“…In this synthesis, although the target was not to quantify the risk factors, there are few prominent risk factors that were reflected in most of the studies. Factors like poor-socio economic conditions, 10,17,[24][25][26][27]31,33,38 disease awareness, 17,21,24,25,28,40 ignorance/myths, 10,18,20,21,24,26,28 addictions, 17,18,21,[26][27][28][29]32,33,40 stigma, 19,20,38 family support 27,29,32 found to be the major contributing factors in the demand-side exploration. Similarly, in the systemside exploration, factors like an attitude of the health-care staff, 21,24,26 delay in referral for diagnosis 10,19,26 were found to be the major contributing factors.…”

“…At the individual level, diverse factors were documented. On a broader scale, poverty, 17,32 unemployment and financial constraints, 10,17,[24][25][26][27]31,33,38 migration, 26 illiteracy 40 stands as major factors, as documented in most of the studies. Followed which, awareness about the disease/ availability of services, 17,21,24,25,28,40 ignorance or selftreating symptoms, 10,18,20,21,24,26,28 myths/wrong beliefs, shame/confidentiality issues 21 found to be significant contributors.…”