A qualitative study of perspectives on access to tuberculosis health services in Xigaze, China

Abstract

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 indifferent 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 effects and worry about treatment effectiveness. Enablers to accessing care identified 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 identified 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. Graphic abstract

Risk factors associated with unsuccessful tuberculosis treatment outcomes in Hunan Province, China

“…Although TB reporting is mandatory in China, there may be potential under‐reporting [ 48] . Patients may also seek care from traditional healers and therefore not be captured in the database [ 49] .…”

Dissaving In the Era of “Free” Care for Tuberculosis (TB): A Qualitative Exploration of Financial Coping and Enablers Among Patients with Co-Prevalent TB-HIV/ TB-Diabetes in Bhavnagar Region, Western India

“…22,25 Support of field workers, free treatment, free hospitalization, and family support were enlisted as enabling factors to access health services under the TB program in China. 23 The enabling factors reported in our study highlight the decentralized model of TB care in India.…”

“…19,20 Evidence on enabling factors under the TB program is mainly focused on adherence to the treatment, barring a few studies. [21][22][23] Our study explored the negative financial coping mechanisms employed and the enabling factors perceived by patients with TB-HIV/ TB-diabetes co-prevalence and also explored the perceptions of program managers of TB in the Bhavnagar region (western India).…”

Gaps in the Utilization of Community Health Services for the Elderly Population in Rural Areas of Mainland China: A Systematic Review Based on Cross-Sectional Investigations

“…Chronic diseases have swept through China's rural areas, 54 the cost of health services has become a heavy burden for elderly individuals in rural areas, and medical expenditure accounts for a large part of their daily expenditure, [55][56][57] while only a few chronic diseases and medicines are covered by the insurance system. 58 As a result of low income and high expenditure, rural elderly individuals fall into deep poverty. In the face of risks, especially disease risks, rural elderly individuals have insufficient financial capacity to pay.…”