Approachability:
Outreach—lack of patient tracking and follow-up35 42 50 Referrals from clinics or private facilities to DRTB care centres not done42 43 50 Poor HCW information or knowledge of TB, resistance, guidelines or algorithms31 35 39–41 46 67 Lack of guideline knowledge and adherence28 31 34 42
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Ability to perceive:
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Raise public awareness of symptoms and the need for early care32 40 Improve HCW knowledge/training and supervision on TB surveillance, resistance monitoring, guidelines and algorithms.27 29 31 39 41 42 44 46 47 53 Improve surveillance, data management, referral and screening, eg, intensified case finding, appointment of dedicated linkage officers in each district.28 30 32 34 35 39 41 43 44 46 47 50 51 Increase access to newer, rapid diagnostics point-of-care Xpert and ensure proper deployment and use.7 36 38 41 44 49 51–53 67 Use of home visits or alert systems to follow-up patients35 40–42 Broad-based policies and strategies to improve screening41 47 51 |
Acceptability:
Professional values, norms and attitude45 Care attributes—infection control, long duration of hospitalisation/treatment40 45
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Ability to seek:
Personal and social values32 36 Disclosure and confidentiality31 45 Culture and gender norms32 Work and family commitments32 Patient sociodemographic characteristic, treatment history and comorbidities27 30 33 39 43 44 50 51 Choosing alternative care32 Fear of infection, delays or side effects29 32 40
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Improve service delivery including integration and retention in care, eg, appointment of linkage officers in each district.2 4 6 20 Reduce hospitalisation duration45 - Strengthen infection control measures and occupational health services.29 31 40 45 Increase home-based care of DR-TB42 45 Improve visitation policies for hospitalised patients45 More attention to patient-level barriers.29 33 |
Structural access dimensions and barriers
(study ID #) |
Patients access dimensions and barriers
(study ID #) |
Recommendations
(study ID #) |
Availability: coverage/centralisation of services7 37
Bed spaces for hospitalisation phase51 Health products: inadequate supplies of diagnostics and drugs67 Personnel: shortages in HCW quantity and quality45 47 Laboratory and clinic operational errors and delays27 28 31 34 37 47 51 53 54 Inadequate access to or low utilisation of newer diagnostic instruments7 27 32 35 38 49 52 54 67 Regional operational differences27 33
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Ability to reach:
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Decentralising, linking and integrating services7 33 37 40 41 51 Improve social and psychosocial support45 Increase HCW quantity and quality.47 Enable same day treatment initiation after Xpert37 Two sputum specimen at baseline27 Increase capacity and quality of inpatient and community-based care51 Ensuring continuous supply of health products.49 Expanded and timely access to treatment regimens, facilities and strategies.8 21 23 |
| Affordability:
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Ability to pay:
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