Online Program

Patient-informed policy change: A qualitative study of barriers to free treatment for latent tuberculosis infection in Peruvian shantytowns

Monday, November 2, 2015

Katherine Vergara, MPH, PhD candidate, School of Public Health, University of Illinois - Chicago, Chicago, IL
Mariano Matias Iberico Lozada, MD, IFHAD: Innovation For Health And Development, IFHAD: Innovation For Health And Development, LID#218, Universidad Peruana Cayetano Heredia, Lima, Peru., Lima, Peru
Marco Tovar, MD, IPSYD: Innovacioìn Por la Salud Y Desarrollo, Lima, Peru
Rosario Montoya, RN, IPSYD: Innovacioìn Por la Salud Y Desarrollo, Lima, Peru
Betty Valiente, RN, IPSYD: Innovacioìn Por la Salud Y Desarrollo, Lima, Peru
Claudio Rocha, MD, IPSYD: Innovacioìn Por la Salud Y Desarrollo, Lima, Peru
Karine Zevallos, MD, IPSYD: Innovacioìn Por la Salud Y Desarrollo, Lima, Peru
Carlton A Evans, MD PhD, Infectious Diseases & Immunity, Imperial College London, London, England
Background: Close contacts of patients with active tuberculosis in Peru are eligible for free latent tuberculosis infection treatment (LTBIT), which is safe and effective. However, only approximately 35% commence and 12% adequately complete LTBIT.

Objective: The reasons for this poor LTBIT uptake are poorly characterized so we addressed this knowledge gap with a qualitative study.

Methods: Semi-structured, qualitative interviews were conducted with members of households of patients with active tuberculosis disease to explore opportunities to improve uptake and adherence and help inform policy. Themes emerged through methodology modeled on Grounded Theory and were analyzed with the Dedoose program to find similarities in knowledge, beliefs and attitudes in the caretakers of tuberculosis patient contacts. The data were coded to reflect themes including time adhered to LTBIT, reasons for discontinuing use, barriers to LTBIT uptake, experience of the healthcare system, and tuberculosis knowledge.

Findings: Stigma and fear of tuberculosis and inaccurate tuberculosis knowledge were frequent. The most significant barriers to LTBIT uptake were a lack of awareness of LTBIT confounded by high indirect costs of accessing LTBIT. Families with no LTBIT uptake often expressed that they knew nothing about LTBIT and were unaware that it was recommended for them. Many also believed that giving healthy children pills would weaken them. Family members usually believed that tuberculosis was transmitted via cutlery, so believed that separate eating utensils were needed to protect children rather than LTBIT.

Conclusions: These patient-identified barriers to care are critical in developing tuberculosis preventive therapy policy changes in resource-limited settings.

Learning Areas:

Planning of health education strategies, interventions, and programs
Protection of the public in relation to communicable diseases including prevention or control
Provision of health care to the public
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy

Learning Objectives:
Discuss patient-identified barriers to the uptake of Isoniazid Preventive Therapy in a shantytown on the outskirts of Lima, Peru Formulate targeted national TB preventive treatment policy in developing country settings

Keyword(s): Tuberculosis, International Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal on federally funded grants focusing on infectious diseases and co-infections in Peru since 2003. Among my scientific interests has been the investigation of emerging infectious diseases and health systems in the developing country setting.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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