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Why wait? The social determinants underlying tuberculosis diagnostic delay

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dc.contributor.author Bonadonna, Lily Victoria
dc.contributor.author Saunders, Matthew James
dc.contributor.author Zegarra, Roberto
dc.contributor.author Evans, Carlton
dc.contributor.author Alegria-Flores, Kei
dc.contributor.author Guio, Heinner
dc.date.accessioned 2019-01-25T16:20:56Z
dc.date.available 2019-01-25T16:20:56Z
dc.date.issued 2017
dc.identifier.uri https://hdl.handle.net/20.500.12866/4799
dc.description.abstract BACKGROUND: Early detection and diagnosis of tuberculosis remain major global priorities for tuberculosis control. Few studies have used a qualitative approach to investigate the social determinants contributing to diagnostic delay and none have compared data collected from individual, community, and health-system levels. We aimed to characterize the social determinants that contribute to diagnostic delay among persons diagnosed with tuberculosis living in resource-constrained settings. METHODS/PRINCIPLE FINDINGS: Data were collected in public health facilities with high tuberculosis incidence in 19 districts of Lima, Peru. Semi-structured interviews with persons diagnosed with tuberculosis (n = 105) and their family members (n = 63) explored health-seeking behaviours, community perceptions of tuberculosis and socio-demographic circumstances. Focus groups (n = 6) were conducted with health personnel (n = 35) working in the National Tuberculosis Program. All interview data were transcribed and analysed using a grounded theory approach. The median delay between symptom onset and the public health facility visit that led to the first positive diagnostic sample was 57 days (interquartile range 28-126). The great majority of persons diagnosed with tuberculosis distrusted the public health system and sought care at public health facilities only after exhausting other options. It was universally agreed that persons diagnosed with tuberculosis faced discrimination by public and health personnel. Self-medication with medicines bought at local pharmacies was reported as the most common initial health-seeking behaviour due to the speed and low-cost of treatment in pharmacies. Most persons diagnosed with tuberculosis initially perceived their illness as a simple virus. CONCLUSIONS: Diagnostic delay was common and prolonged. When individuals reached a threshold of symptom severity, they addressed their health with the least time-consuming, most economically feasible, and well-known healthcare option available to them. In high-burden settings, more human and material resources are required to promote tuberculosis case-finding initiatives, reduce tuberculosis associated stigma and address the social determinants underlying diagnostic delay. en_US
dc.language.iso eng
dc.publisher PLoS
dc.relation.ispartof urn:issn:1932-6203
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Peru en_US
dc.subject Adult en_US
dc.subject Female en_US
dc.subject Humans en_US
dc.subject Male en_US
dc.subject Social Support en_US
dc.subject Young Adult en_US
dc.subject Middle Aged en_US
dc.subject Interviews as Topic en_US
dc.subject Time Factors en_US
dc.subject Focus Groups en_US
dc.subject Tuberculosis, Pulmonary/diagnosis en_US
dc.subject Social Determinants of Health/statistics & numerical data en_US
dc.subject Delayed Diagnosis/statistics & numerical data en_US
dc.title Why wait? The social determinants underlying tuberculosis diagnostic delay en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1371/journal.pone.0185018
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00 es_PE
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.07
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#5.04.00


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