Understanding barriers to tuberculosis diagnosis and treatment completion in a low-resource setting: A mixed-methods study in the Kingdom of Lesotho.
<h4>Background</h4>Lesotho is one of the 30 countries with the highest tuberculosis incidence rates in the world, estimated at 650 per 100,000 population. Tuberculosis case detection is extremely low, particularly with the rapid spread of COVID-19, dropping from an estimated 51% in 2020...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2023-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0285774 |
| _version_ | 1797802079378472960 |
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| author | Afom T Andom Hannah N Gilbert Melino Ndayizigiye Joia S Mukherjee Christina Thompson Lively Jonase Nthunya Tholoana A Marole Makena Ratsiu Mary C Smith Fawzi Courtney M Yuen |
| author_facet | Afom T Andom Hannah N Gilbert Melino Ndayizigiye Joia S Mukherjee Christina Thompson Lively Jonase Nthunya Tholoana A Marole Makena Ratsiu Mary C Smith Fawzi Courtney M Yuen |
| author_sort | Afom T Andom |
| collection | DOAJ |
| description | <h4>Background</h4>Lesotho is one of the 30 countries with the highest tuberculosis incidence rates in the world, estimated at 650 per 100,000 population. Tuberculosis case detection is extremely low, particularly with the rapid spread of COVID-19, dropping from an estimated 51% in 2020 to 33% in 2021. The aim of this study is to understand the barriers to tuberculosis diagnosis and treatment completion.<h4>Methods</h4>We used a convergent mixed methods study design. We collected data on the number of clients reporting symptoms upon tuberculosis screening, their sputum test results, the number of clients diagnosed, and the number of clients who started treatment from one district hospital and one health center in Berea district, Lesotho. We conducted in-depth interviews and focus group discussions with 53 health workers and patients. We used a content analysis approach to analyze qualitative data and integrated quantitative and qualitative findings in a joint display.<h4>Findings</h4>During March-August, 2019, 218 clients at the hospital and 292 clients at the health center reported tuberculosis symptoms. The full diagnostic testing process was completed for 66% of clients at the hospital and 68% at the health center. Among clients who initiated tuberculosis treatment, 68% (61/90) at the hospital and 74% (32/43) at the health center completed treatment. The main barriers to testing and treatment completion were challenges at sample collection, lack of decentralized diagnostic services, and socioeconomic factors such as food insecurity and high patient movement to search for jobs.<h4>Conclusions</h4>Tuberculosis diagnosis could be improved through the effective decentralization of laboratory services at the health facility level, and treatment completion could be improved by providing food and other forms of social support to patients. |
| first_indexed | 2024-03-13T05:00:16Z |
| format | Article |
| id | doaj.art-fbb132e4dc00444cbb6426d4c94def68 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-03-13T05:00:16Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-fbb132e4dc00444cbb6426d4c94def682023-06-17T05:31:31ZengPublic Library of Science (PLoS)PLoS ONE1932-62032023-01-01185e028577410.1371/journal.pone.0285774Understanding barriers to tuberculosis diagnosis and treatment completion in a low-resource setting: A mixed-methods study in the Kingdom of Lesotho.Afom T AndomHannah N GilbertMelino NdayizigiyeJoia S MukherjeeChristina Thompson LivelyJonase NthunyaTholoana A MaroleMakena RatsiuMary C Smith FawziCourtney M Yuen<h4>Background</h4>Lesotho is one of the 30 countries with the highest tuberculosis incidence rates in the world, estimated at 650 per 100,000 population. Tuberculosis case detection is extremely low, particularly with the rapid spread of COVID-19, dropping from an estimated 51% in 2020 to 33% in 2021. The aim of this study is to understand the barriers to tuberculosis diagnosis and treatment completion.<h4>Methods</h4>We used a convergent mixed methods study design. We collected data on the number of clients reporting symptoms upon tuberculosis screening, their sputum test results, the number of clients diagnosed, and the number of clients who started treatment from one district hospital and one health center in Berea district, Lesotho. We conducted in-depth interviews and focus group discussions with 53 health workers and patients. We used a content analysis approach to analyze qualitative data and integrated quantitative and qualitative findings in a joint display.<h4>Findings</h4>During March-August, 2019, 218 clients at the hospital and 292 clients at the health center reported tuberculosis symptoms. The full diagnostic testing process was completed for 66% of clients at the hospital and 68% at the health center. Among clients who initiated tuberculosis treatment, 68% (61/90) at the hospital and 74% (32/43) at the health center completed treatment. The main barriers to testing and treatment completion were challenges at sample collection, lack of decentralized diagnostic services, and socioeconomic factors such as food insecurity and high patient movement to search for jobs.<h4>Conclusions</h4>Tuberculosis diagnosis could be improved through the effective decentralization of laboratory services at the health facility level, and treatment completion could be improved by providing food and other forms of social support to patients.https://doi.org/10.1371/journal.pone.0285774 |
| spellingShingle | Afom T Andom Hannah N Gilbert Melino Ndayizigiye Joia S Mukherjee Christina Thompson Lively Jonase Nthunya Tholoana A Marole Makena Ratsiu Mary C Smith Fawzi Courtney M Yuen Understanding barriers to tuberculosis diagnosis and treatment completion in a low-resource setting: A mixed-methods study in the Kingdom of Lesotho. PLoS ONE |
| title | Understanding barriers to tuberculosis diagnosis and treatment completion in a low-resource setting: A mixed-methods study in the Kingdom of Lesotho. |
| title_full | Understanding barriers to tuberculosis diagnosis and treatment completion in a low-resource setting: A mixed-methods study in the Kingdom of Lesotho. |
| title_fullStr | Understanding barriers to tuberculosis diagnosis and treatment completion in a low-resource setting: A mixed-methods study in the Kingdom of Lesotho. |
| title_full_unstemmed | Understanding barriers to tuberculosis diagnosis and treatment completion in a low-resource setting: A mixed-methods study in the Kingdom of Lesotho. |
| title_short | Understanding barriers to tuberculosis diagnosis and treatment completion in a low-resource setting: A mixed-methods study in the Kingdom of Lesotho. |
| title_sort | understanding barriers to tuberculosis diagnosis and treatment completion in a low resource setting a mixed methods study in the kingdom of lesotho |
| url | https://doi.org/10.1371/journal.pone.0285774 |
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