Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #111637

Charlotte Colvin, MA and Kate Macintyre, PhD. International Health, Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, 504-988-1348, ccolvin@tulane.edu

The resurgence of TB in Honduras throughout the 1990's has resulted in new efforts to improve case management, including the internationally recognized DOTS strategy. While the National TB Program has achieved very high rates of treatment success, case detection remains undesirably low. This study was undertaken to identify barriers to care for symptomatic individuals seeking care at the primary health care center in an urban area with high rates of TB/HIV co-infection. A cross-sectional survey was conducted among patients presenting with cough of more than 15 days at 8 public sector clinics, using a standardized questionnaire and face-to-face interviews with local research assistants. The data were analyzed with a binary logistic regression model; hypothesized relationships between key independent variables and delay (0=less than 3 weeks, 1=more than 3 weeks) in seeking treatment were explored. Age and location of clinic were found to be significant predictors of delayed health seeking. Recommendations include greater recognition of structural barriers in research on barriers to care, such as those related to the health system. Additionally, there is a need for more community-based research in this area, as most published research is facility-based, which provides a biased view of the behavioral and structural barriers to TB diagnosis.

Learning Objectives: At the end of the session, the participant will be able to

• Identify structural barriers to health seeking behavior in a specific context.
• Discuss challenges posed by TB/HIV co-infection for program managers in low-resource settings, specifically, barriers to diagnosis for both illnesses.
• Articulate alternative study designs for the investigation of barriers to health seeking behavior.

Keywords: Tuberculosis, Access to Health Care

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation