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Phnom Penh, Cambodia

Lorent N.,Institute of Tropical Medicine | Lorent N.,University Hospitals Leuven | Malhotra S.,Global Alliance for TB Drug Development | Koeut P.,CENAT | And 4 more authors.
PLoS ONE | Year: 2015

Background While community-based active case finding (ACF) for tuberculosis (TB) holds promise for increasing early case detection among hard-to-reach populations, limited data exist on the acceptability of active screening. We aimed to identify barriers and explore facilitators on the pathway from diagnosis to care among TB patients and health providers. Methods Mixed-methods study.We administered a survey questionnaire to, and performed in-depth interviews with, TB patients identified through ACF from poor urban settlements in Phnom Penh, Cambodia. Additionally, we conducted focus group discussions and in-depth interviews with community and public health providers involved in ACF, respectively. Results Acceptance of home TB screening was strong among key stakeholders due to perceived reductions in access barriers and in direct and indirect patient costs. Privacy and stigma were not an issue. To build trust and facilitate communication, the participation of community representatives alongside health workers was preferred. Most health providers saw ACF as complementary to existing TB services; however, additional workload as a result of ACF was perceived as straining operating capacity at public sector sites. Proximity to a health facility and disease severity were the strongest determinants of prompt care-seeking. The main reasons reported for delays in treatment-seeking were non-acceptance ofdiagnosis, high indirect costs related to lost income/productivity and transportation expenses, and anticipated side-effects from TB drugs. Conclusions TB patients and health providers considered home-based ACF complementary to facilitybased TB screening. Strong engagement with community representatives was believed critical in gaining access to high risk communities. The main barriers to prompt treatment uptake in ACF were refusal of diagnosis, high indirect costs, and anticipated treatment sideeffects. A patient-centred approach and community involvement were essential in mitigating barriers to care in marginalised communities. © 2015 Lorent et al. Source

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