title: Knowledge and attitudes of tuberculosis management in San Juan de Lurigancho district of Lima, Peru.
abstract: BACKGROUND
  Expansion of the health care workforce in Peru to combat tuberculosis (TB) includes both professional health care providers (HCPs) such as doctors and nurses, and non-professional HCPs such as community health workers (CHWs). We describe the knowledge and attitudes of these HCPs, and identify modifiable barriers to appropriate anti-tuberculosis treatment.
  
  
  METHODS
  We surveyed HCPs practicing in 30 clinical settings (hospitals, community health centers, and health posts) in the San Juan de Lurigancho district of Eastern Lima, Peru. Multiple-choice questions were used to assess knowledge of TB. A five-item Likert scale was created to assess attitudes toward the community, patients, and clinics. Linear regression was used to identify predictors of mean knowledge score, and analysis of variance was used to test differences in HCP score.
  
  
  RESULTS
  Of the 73 HCPs surveyed, 15% were professionals (doctors or nurses). The remaining 85% were health technicians, community health workers (CHWs) or students. The mean knowledge score was 10.0 +/- 1.9 (maximum 14) with professional HCPs scoring higher than other HCPs (11.7 +/- 1.1 vs. 9.7 +/- 1.9), p < .01). Knowledge gaps included identification of patients at high risk for TB, assessment of treatment outcomes, and consequences of treatment failure. The most commonly cited modifiable barriers were structural, including laboratory facilities and staffing of TB clinics, with 52.1% and 62.5% of HCPs, respectively, citing these as problematic.
  
  
  CONCLUSIONS
  Efforts to improve knowledge of TB HCPs in Peru should focus on the specific gaps we have identified. Further research is needed to evaluate whether these knowledge gaps correlate with TB control.
authors.affiliation: Montefiore Medical Center, Bronx, NY, USA. emkiefer@gmail.com
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Kiefer
authors.forename: Theresa
authors.initials: T
authors.lastname: Shao
authors.forename: Olveen
authors.initials: O
authors.lastname: Carrasquillo
authors.forename: Pamela
authors.initials: P
authors.lastname: Nabeta
authors.forename: Carlos
authors.initials: C
authors.lastname: Seas
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D010568:Peru; D011795:Surveys and Questionnaires; D014397:Tuberculosis, Pulmonary / Q000523:psychology* / Q000628:therapy