| 1. |
(14) |
Determine
which programmatic obstacles prevent patients with
coinfection with HIV and tuberculosis from receiving comprehensive
care. |
In-depth interviews |
Peru |
16 health providers, 4 patients, and 2 officials |
Thematic content analysis |
A lack of coordination between
HIV and tuberculosis teams,
managing HIV and tuberculosis patients separately at different stages
of care, inadequate funding, a shortage of skilled staff, and the
lack of an information system were the obstacles that were found. |
| 2. |
(15) |
To comprehend the obstacles that
exist in receiving a TB diagnosis
and completing treatment in Lesotho. |
In-depth interviews
and focus group discussions |
Lesotho |
24
patients, 15 health care workers, and 14 nurses |
Thematic
content analysis |
Challenges during sample collection,
a lack of decentralized
diagnostic services, and socioeconomic reasons like food hardship
and high patient mobility for job searches were the main obstacles
to testing and treatment completion. |
| 3. |
(16) |
To investigate what favors and what hinders people in Xigaze,
China, from obtaining and staying in touch with TB care services. |
In-depth interviews |
China |
23 TB
patients |
Thematic content analysis |
Patients
reported complicated care paths that frequently required
numerous hospital visits, as well as limited awareness of and an indifferent
attitude toward tuberculosis. They had trouble physically accessing
care, and they had to pay for tests, diagnostics, and transportation
out of pocket. Concerns regarding the efficacy of treatments and the
negative effects of medications were obstacles to continuing care. |
| 4. |
(17) |
To evaluate women’s access
to healthcare and the general
public’s knowledge of tuberculosis. |
Focus group
discussions and semistructured interview |
Pakistan |
36 women |
Deductive analysis based on the SEM
(socio ecological model)
and inductive analysis |
Access to healthcare for women
is hampered by a number of factors,
including low autonomy in household financial decision-making, disapproval
of unassisted travel, long travel distances, a lack of spending priority
on women’s health, and an inadequate number of female health
providers. This number is even higher for younger women. |
| 5. |
(18) |
To examine the narratives of individuals
diagnosed with multidrug-resistant
tuberculosis, their understanding of how they came to have this illness,
and the obstacles they faced when trying to get treatment during the
COVID-19 pandemic in a priority city in Brazil. |
Semistructured
interview |
Brazil |
7 patients who are undergoing
treatment for MDR-TB |
French Discourse Analysis |
COVID-19 was a significant obstacle for people who needed medical
attention. When it came to going back to their doctor’s appointments,
many patients expressed fear, nervousness, and anxiety. |
| 6. |
(6) |
To determine the causes of Nigeria’s
low DR-TB case
detection and treatment rates. |
Documentation review
of employee handbooks and guidelines and
semistructured interviews |
Nigeria |
127
TB patients, their treatment supporter, and providers |
Thematic content analysis |
Unequal patient sociodemographic
groups’ access to DR-TB
care. Certain patients had more trouble getting care because of their
gender, age, occupation, educational background, or religion. Access
was probably hindered by restricted coverage and the lack of protection
for patients’ access rights as well as considerations in the
treatment guidelines and worker manuals. |
| 7. |
(19) |
To investigate, from the perspective of the healthcare
professionals
executing TB care, the obstacles and enablers to bidirectional screening. |
In-depth interviews |
Ghana |
23 healthcare
workers |
Thematic content analysis |
Obstacles
included skewed funding for screening, fear and stigmatization
of tuberculosis, poor teamwork between TB and DM units, and delays
in screening. |
| 8. |
(7) |
To describe
the socioeconomic impediments and enablers to TB
service access in Nepal |
Semistructured focus group discussions |
Nepal |
14 patients with TB, of which 7 had multidrug
resistant TB;
6 community leaders, 7 grass-roots community organizations, and 12
TB health professionals |
Thematic content analysis |
Socioeconomic hurdles to getting TB services include income
loss, stigma, high food and transportation costs, and a lack of awareness
and activism around TB. |
| 9. |
(9) |
Evaluation of Mozambique’s DS-TB, HIV/TB, and MDR-TB
service quality, as well as the difficulties in successfully preventing,
diagnosing, and treating TB. |
Focus group discussions |
Mozambique |
51 TB patients |
Thematic
content analysis |
Many obstacles were noted by the respondents,
such as long
wait times at medical facilities, stigma associated with diagnosis
and treatment, delayed diagnosis, lack of nutritional support for
TB patients, lack of a comprehensive psychosocial support program,
and low community awareness of TB or multidrug-resistant TB. |
| 10. |
(20) |
To comprehend the difficulties
faced by TB patients from Myanmar
who reside near the border between Thailand and Myanmar in getting
access to a TB clinic in a Thai hospital. |
In-depth interviews |
Thailand |
22 TB patients, patients’ relatives
and health care
providers |
Thematic content analysis |
Issues
with language and finances, lengthy wait times and little
information about the infection, excessive workload, and the inappropriateness
of some techniques or technologies, Thailand’s national universal
insurance program does not subsidize foreign TB patients, and it may
occasionally be necessary to return TB patients to their home nation. |
| 11. |
(21) |
To investigate impediments to
accessing TB health care, including
confirmatory diagnosis, treatment adherence, and recurrence of pulmonary
tuberculosis, from the perspectives of patients, physicians, and policymakers. |
Semistructured in-depth interview |
Iran |
33 TB patients |
Thematic content analysis |
Patients’ poor knowledge of TB symptoms, physicians’
failure to screen for TB among at-risk patients, similar symptoms
between TB and other lung diseases, low sensitivity of TB diagnostic
tests, incomplete case finding and contact-tracing, stigma associated
with TB, and patients’ poor adherence to long-term TB treatment. |
| 12. |
(22) |
To investigate obstacles to accessing TB care
and information gaps by gender and critical demographics. |
Consultative meetings, comprehensive desk review,
in-depth interviews and focus group discussion |
Cambodia |
39 people living
with HIV, 31 TB survivors, 41
aged 55 and older, 30 close contacts of people with smear-positive
TB, five people with diabetes, 8 prisoners, 20 people who use drugs,
and 32 service providers |
Thematic content
analysis |
Lack of knowledge and awareness around tuberculosis |
| Insufficient funds and time; Gender-specific impediments
in
access to TB services |
| Lack of resources in
health centers to support proper care
of tuberculosis |
| 13. |
(23) |
To describe social and behavioral health factors
for successful tuberculosis services and management from the standpoint
of miners/ex-miners, health care personnel, and policymakers/managers. |
Ethnographic interviews |
South Africa |
30 miners/ex-miners, 13 family/community
members,
14 health care providers, and 47 local policy makers/managers |
Iterative analysis |
Miners and ex-miners
felt that health-care delivery
systems did not meet their needs. Many had suffered needless mental
and physical suffering because of poor health education on tuberculosis,
low engagement in their own treatment, a lack of trust in medical
professionals, and a system that overlooked their experience. The
stigma and anxiety associated with tuberculosis lead to denial of
symptoms and delays in seeking care. Health care professionals and
policymakers/managers were deterred by system limits in providing
optimal treatment. |
| Corbin and Strauss grounded
theory procedure |
| 14. |
(24) |
To identify
challenges and enablers of TB contact research
during its implementation in Kampala, Uganda. |
Focus
group discussions and interviews |
Kampala, Uganda |
37 nurses, 5 medical officers, 7 clinical officers, 5 lab technicians,
2 counselors, 3 pharmacy technicians, 1 data officer, and 1 multiclinic
supervisor |
COM-B model - Behavior Change Wheel. |
Stigma, poor understanding of tuberculosis among contacts,
insufficient time and space in clinics for counseling, mistrust of
health-care workers among index patients and contacts, and high travel
expenses for LHWs and contacts. |
| 15. |
(25) |
To explore access to TB, TB/HIV, and multidrug-resistant tuberculosis
(MDR-TB) therapy, focusing on barriers to care and enabling variables. |
Informant interviews and focus group discussions |
Thailand |
12 key informants (public health officials
and TB treatment
providers, migrants and refugees who were receiving TB, TB/HIV and
MDR-TB treatment, non-TB patients) |
Thematic content
analysis |
Both migrants and refugees only have access
to and eligibility
for treatment based on their legal status. Migrants seeking treatment
for tuberculosis face financial and nonfinancial impediments to travel
and treatment. Important health system elements that impact accessibility
include the language of health care, access to free or low-cost therapy,
and psychological support. |
| 16. |
(26) |
To comprehend the factors influencing the ease of TB diagnosis.
from the perspective of medical experts. |
Semistructured
interviews |
Paraná and Brazil |
20
nurses and 10 doctors |
Thematic content analysis |
Access to the diagnosis of TB is a difficult deferral of the
tests. |
| 17. |
(27) |
To determine
obstacles to pediatric TB diagnosis in Lima, Peru. |
Focus
group discussions and in-depth interviews |
Peru |
53 primary care providers, community health workers, and parents
and/or guardians of pediatric TB patients |
Inductive
thematic Analysis |
Lack of knowledge and stigma in the
community, poor follow-up,
restricted availability of diagnostic testing, staff at health centers
with insufficient training, and a scarcity of providers. The difficulty
of collecting sputum and the limited sensitivity of culture and smear
microscopy. |
| 18. |
(28) |
To examine
the sociocultural, geographic, economic, and health
system barriers that prevent individuals in Yemen from undergoing
and completing the TB testing procedure. |
In-depth- interviews
and focus group discussions |
Yemen |
497
TB suspects |
Thematic content analysis |
The majority of patients had low literacy and were underprivileged,
had left rural regions to travel for treatment. Other barriers to
TB treatment were distance from home, high social stigma, expense
of the clinic and transportation (increased by companions), and ignorance
of the diagnostic procedure. Patients have no idea that tuberculosis
treatment is free. Referrals to the private sector deterred patients
from returning as well. |
| 19. |
(29) |
To give a contextualized knowledge of how individuals with
disabilities might obtain TB care in a particular southern Malawi
district. |
Semistructured interviews and site observations |
Malawi |
47 persons with disability, 11 parents/guardians
of youths
with disability, eight health workers, four community rehabilitation
assistants and volunteers, and 19 leaders in the community |
Thematic content analysis |
Inadequate knowledge
and information. Challenges to taking
tests. Logistic and operational impediments. Absence of disability-specific
policies in the community’s health services |
| 20. |
(30) |
To examine the obstacles to older people’s
TB diagnosis
and their access to medical care in João Pessoa, Paraíba,
Brazil |
Semi structured interviews |
Brazil |
7 elderly people with TB |
French discourse analysis |
Family health unit operation hours; delegated duties; home
visits without communicant control; wait times for the health service
to detect a sickness and for the patient to visit the center many
times before receiving a diagnosis. |
| 21. |
(31) |
To comprehend the obstacles TB patients, face when attempting
to access medical treatment. |
In-depth interviews |
Pakistan |
23 TB patients and 15 health personnel |
Thematic content analysis |
Long distance from
health facility, lack of patient awareness,
job loss, financial strain, and social stigma |
| 22. |
(32) |
To outline the difficulties impoverished rural Zambians
living
with HIV and TB encountered in getting access to ART. |
Focus group discussions and semistructured individual interviews |
Zambia |
14 TB patients and their households |
Thematic content analysis |
Financial obstacles,
societal obstacles. discrimination and
the challenge of transparency, barriers seen at health facilities. |
| 23. |
(33) |
To determine and comprehend the
limitations that managers and
community care workers (CCWs) perceive in the health systems that
affect the execution of joint TB/HIV initiatives, such as PMTCT (prevention
of mother-to-child transmission of HIV). |
In-depth interviews
and focus group discussions |
South-Africa |
33 health managers and managers of NGOs involved in TB and
HIV care, CCWs |
Thematic content analysis |
The strategy was not implemented with enough consultation,
and there was a lack of political will and leadership. Health systems
hurdles are mostly associated with constraints connected to organizational
culture and structure; management, planning, and power concerns; uneven
finance; human resource capability; and regulatory issues, particularly
those pertaining to the scope of practice of nurses and CCWs. |
| 24. |
(34) |
To investigate the factors causing
pastoralist TB patients
in Ethiopia’s Somali Regional State (SRS) to postpone diagnosis. |
Consultation sessions and open interviews |
Ethiopia |
Seven pastoralist TB patients |
Thematic content
analysis |
Prompt biomedical diagnosis of tuberculosis
(TB) among pastoralist
TB patients in the Southern Region of Ethiopia was impeded by limited
access to professional health care and cultural beliefs that encouraged
self-treatment. |
| 25. |
(35) |
To investigate
factors that help and hinder the management
of tuberculosis therapy in Addis Ababa, Ethiopia, during the first
five months of treatment. |
In-depth interviews and focus
groups discussions |
Ethiopia |
44 TB patients,
their relatives and health personnel |
Systematic text
condensation |
Employment loss. Routines at health clinics
were strict, requiring
a lot of time and physical exertion every day. Particularly susceptible
to nonadherence were patients who were impoverished as a result of
their disease or delayed course and who were unable to improve their
social standing and general state of health. |
| 26. |
(36) |
To comprehend the health-seeking behavior of these
individuals
as well as the responses of the health systems to their persistent
cough in order to determine the variables impacting the delays that
both permanent urban residents and migrants experience in acquiring
a TB diagnosis in urban China. |
Focus group discussions
and semistructured interviews |
China |
20
TB ’suspects’, 17 TB patients and 23 key informants
(health managers and health workers) |
Thematic content
analysis |
Inadequate prescription of diagnostic tests
and referral to
TB clinics by general health practitioners; limited financial ability
to pay for care and diagnostic testing; little awareness and poor
understanding of tuberculosis (TB) and the TB control program among
the general population and TB suspects all serve as obstacles to diagnosis. |
| 27. |
(37) |
To investigate disparities between
genders in behavior related
to seeking care, access to treatment, and understanding and views
on TB. |
Semistructured questionnaires |
The
Gambia |
15 government health and 30 TB patients |
Thematic content analysis |
Due to time restrictions,
higher secrecy, and stronger traditional
values, women were more likely to employ traditional healers. All
patients, regardless of gender, admitted to having trouble paying
for the transportation expenses required to get to the clinic. Patients’
and healthcare professionals’ unfavorable opinions of TB were
brought to light. It was commonly claimed that stigma and ignorance
about TB were worse among female patients. |
| 28. |
(38) |
To determine what obstacles and enablers exist
at the patient and healthcare system levels in Uganda for the start
of TB therapy. |
In-depth interviews |
Uganda |
31 patients,
10 health managers and 38 healthcare
workers |
Thematic analysis |
Inadequate documentation of patient addresses,
inability to obtain sputum results from the laboratory, and ignorance
of the percentage of patients who are not started on tuberculosis
therapy Notable obstacles for patients were delayed sputum results
turnaround times and insufficient funds for transportation back to
medical facilities (physical opportunity); stigma (social opportunity)
and inadequate awareness of tuberculosis (psychological competence). |
| COM-B > model. |
| Behavior Change Wheel. |
| 29. |
(39) |
To comprehend the experiences of patients in Rio de
Janeiro
State, Brazil, about the challenges they encountered during the diagnosis
and treatment of multidrug-resistant TB, as well as the resulting
effects. |
Semistructured interviews |
Brazil |
31 patients undergoing treatment for multidrug-resistant tuberculosis |
Thematic content analysis |
Multidrug-resistant
TB takes longer to diagnose and treat in
patients; healthcare professionals do not value or pursue the diagnosis
of drug-resistant tuberculosis, poor report rates of active case-finding
and contact tracking in primary health centers, insufficient treatment
for drug-susceptible TB, and patients display a lack of understanding
of the illness. |
| 30. |
(40) |
To determine
potential obstacles to TB centered diagnosis the
northwest Ethiopian region of East Gojjam Zone. |
In-depth
interviews and focus-group discussions |
Ethiopia |
21 TB patients, 6 TB control officers, and 40 health workers |
Thematic content analysis |
Health facility barriers
include health service delay, using
only passive TB centered diagnosis strategy, poor health education
provision, lack of continuous oversight and timely feedback, and residence
in a rural area, low income, poor health literacy, and delayed health-seeking.
Health workers’ barriers include a shortage of HWs, limited
training access, and low level of knowledge and skills. |
| 31. |
(41) |
To investigate and contrast the diagnosis
and treatment start
pathways experienced by MDR-TB patients using Xpert MTB/RIF-based
diagnostic methods and GenoType MTBDRplus. |
In-depth
interviews using a semistructured guide |
South Africa |
26 TB patients |
Deductive and inductive analysis, |
Delays may have resulted from patients delaying seeking medical
attention and using the private sector, which was partly caused by
widespread perceptions of subpar public sector treatment. The inability
of healthcare practitioners to test for tuberculosis (TB) during first
patient interactions, deviation from testing protocols, unavailability
of test findings, and delayed patient recall for positive results. |
| 32. |
(42) |
To examine the management topics’
discourse on the elderly’s
delayed diagnosis of tuberculosis in municipalities in the Curimataú-Paraíba
area. |
Interviews |
Brazil |
9 health managers |
French discourse analysis. |
Delays in seeking medical attention and understanding sickness,
ignorance of the condition, bias, obstacles to receiving care, and
a lack of confidence in the ability of specialists to recognize possible
instances. |
| 33. |
(8) |
To investigate
the variables influencing TB patients’
access to healthcare, diagnosis, and completion of treatment in central
and western Nepal. |
In-depth interviews and focus group
discussions |
Nepal |
202 participants from
communities, private sector health service
provider, government health service providers, a traditional health
service provider; TB patients and suspected patients |
Thematic content analysis |
Long distance, bad roads,
and travel expenses. In addition,
there was a misconception that early detection of tuberculosis was
hampered by a lack of equipment, a shortage of educated medical professionals,
and sporadic medical staff attendance. The stigma, the rigorous treatment
schedule, and the requirement to attend health centers every day for
DOTS treatment posed further obstacles to adherence and treatment
completion. |
| 34. |
(43) |
To comprehend
the obstacles that migrant TB patients in Shanghai
have in receiving care for tuberculosis (TB) following the implementation
of the TB-free treatment strategy. |
In-depth interviews |
China |
34 migrant TB patients |
Thematic
content analysis |
The largest obstacles to TB treatment
among migrant patients
were said to be financial ones. Both prior to and following being
diagnosed with tuberculosis, many migrant patients faced exorbitant
medical expenses. Patients who were immigrants reported being shunned
or fired from their jobs as a result of their TB diagnosis. They also
had little awareness of the free TB treatment program. |
| 35. |
(44) |
To comprehend the obstacles undergraduate
students, face in
controlling and preventing TB. |
In-depth interviews |
China |
10 leaders and health workers in the health-care
department,
12 individuals in the district centers for disease control, and 15
undergraduates with TB |
Thematic content analysis |
The national TB policy is not well-accepted, infirmaries and
district TB control agencies have insufficient staff and operate subparly,
and there is insufficient focus on TB prevention. Additionally, there
is a lack of collaboration in the identification, monitoring, and
treatment of TB-affected students. |
| 36. |
(45) |
To get an understanding of their viewpoints of the variables
influencing the results of patient treatment and to provide possible
programming solutions for improving patient care services. |
Mixed-methods study and in-depth interviews |
Philippines |
272 healthcare workers |
Thematic content analysis |
Inadequate financial and political backing, a shortage of personnel,
and a lack of awareness among healthcare professionals on DRTB. More
detailed, contextualized, and subtle facets of every significant difficulty
were disclosed through interviews. The detailed obstacles related
to patients included costs associated with treatment (such as transportation);
anxiety about stigma from the community, family, or healthcare professionals;
concerns about medication side effects; a lack of family support;
the location of the patients’ homes; the facility staff’s
limited ability to provide DRTB care because of a shortage of personnel;
the lack of funding to support treatment completion (such as transportation
allowance and food packages for patients, service vehicles and cell
phone costs for facility-level outreach actions); and discrimination
against patients with DRTB that was attributed to the staff’s
limited knowledge and experiences of treating the patients |
