title: Barriers and delays in tuberculosis diagnosis and treatment services: does gender matter?
abstract: Background. Tuberculosis (TB) remains a global public health problem with known gender-related disparities. We reviewed the quantitative evidence for gender-related differences in accessing TB services from symptom onset to treatment initiation. Methods. Following a systematic review process, we: searched 12 electronic databases; included quantitative studies assessing gender differences in accessing TB diagnostic and treatment services; abstracted data; and assessed study validity. We defined barriers and delays at the individual and provider/system levels using a conceptual framework of the TB care continuum and examined gender-related differences. Results. Among 13,448 articles, 137 were included: many assessed individual-level barriers (52%) and delays (42%), 76% surveyed persons presenting for care with diagnosed or suspected TB, 24% surveyed community members, and two-thirds were from African and Asian regions. Many studies reported no gender differences. Among studies reporting disparities, women faced greater barriers (financial: 64% versus 36%; physical: 100% versus 0%; stigma: 85% versus 15%; health literacy: 67% versus 33%; and provider-/system-level: 100% versus 0%) and longer delays (presentation to diagnosis: 45% versus 0%) than men. Conclusions. Many studies found no quantitative gender-related differences in barriers and delays limiting access to TB services. When differences were identified, women experienced greater barriers and longer delays than men.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
authors.forename: Wei-Teng
authors.initials: WT
authors.lastname: Yang
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
authors.forename: Celine R
authors.initials: CR
authors.lastname: Gounder
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
authors.forename: Tokunbo
authors.initials: T
authors.lastname: Akande
authors.affiliation: Harvard School of Public Health, Boston, MA 02115, USA.
authors.forename: Jan-Walter
authors.initials: JW
authors.lastname: De Neve
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
authors.forename: Katherine N
authors.initials: KN
authors.lastname: McIntire
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
authors.forename: Aditya
authors.initials: A
authors.lastname: Chandrasekhar
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: de Lima Pereira
authors.affiliation: Narayana Hrudayalaya Hospital, Hyderabad 500055, India.
authors.forename: Naveen
authors.initials: N
authors.lastname: Gummadi
authors.affiliation: All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Santanu
authors.initials: S
authors.lastname: Samanta
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA ; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA ; Center for Clinical Global Health Education, 600 North Wolfe Street, Phipps 540B, Baltimore, MD 21287, USA.
authors.forename: Amita
authors.initials: A
authors.lastname: Gupta