Why wait? The social determinants underlying tuberculosis diagnostic delay

Alegria-Flores, Kei; Bonadonna, Lily Victoria; Saunders, Matthew James; Zegarra, Roberto; Guio, Heinner; Evans, Carlton Anthony William

dc.contributor.author	Bonadonna, Lily Victoria
dc.contributor.author	Saunders, Matthew James
dc.contributor.author	Zegarra, Roberto
dc.contributor.author	Evans, Carlton Anthony William
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	Public Library of Science
dc.relation.ispartofseries	PLoS ONE
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#3.02.07
dc.subject.ocde	https://purl.org/pe-repo/ocde/ford#5.04.00
dc.relation.issn	1932-6203