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BACKGROUND:Nepal has achieved a significant reduction of TB incidence over the past decades. Nevertheless, TB patients continue to experience barriers in access, diagnosis and completion of the treatment. The main objective of this study was to explore the factors affecting the access to the health services, diagnosis and the treatment completion for TB patients in central and western Nepal. METHODS:Data were collected using in-depth interviews (IDI) with the TB patients (n = 4); Focus Group Discussions (FGDs) with TB suspected patients (n = 16); Semi Strucutred Interviews (SSIs) with health workers (n = 24) and traditional healers (n = 2); and FGDs with community members (n = 8). All data were audio recorded, transcribed and translated to English. All transcriptions underwent thematic analysis using qualitative data analysis software: Atlas.ti. RESULTS:Barriers to access to the health centre were the long distance, poor road conditions, and costs associated with travelling. In addition, lack of awareness of TB and its consequences, and the belief, prompted many respondents to visit traditional healers. Early diagnosis of TB was hindered by lack of trained health personnel to use the equipment, lack of equipment and irregular presence of health workers. Additional barriers that impeded the adherence and treatment completion were the need to visit health centre daily for DOTS treatment and associated constraints, complex treatment regimen, and the stigma. CONCLUSIONS:Barriers embedded in health services and care seekers' characteristics can be dealt by strengthening the peripheral health services. A continuous availability of (trained) human resources and equipment for diagnosis is critical. As well as increasing the awareness and collaborating with the traditional healers, health services utilization can be enhanced by compensating the costs associated with it, including the modification in current DOTS strategy by providing medicine for a longer term under the supervision of a family member, peer or a community volunteer.

Original publication

DOI

10.1371/journal.pone.0227293

Type

Journal article

Journal

PloS one

Publication Date

15/01/2020

Volume

15

Addresses

Manmohan Memorial Institute of Health Sciences, Soaltee mode, Kathmandu, Nepal.

Keywords

Humans, Tuberculosis, Medicine, Traditional, Focus Groups, Health Knowledge, Attitudes, Practice, Family, Qualitative Research, Adult, Middle Aged, Health Personnel, Health Services Accessibility, Patient Acceptance of Health Care, Nepal, Female, Male, Young Adult, Social Stigma, Surveys and Questionnaires, Community Participation, Intersectoral Collaboration