title: Listening to Those at the Frontline: Patient and Healthcare Personnel Perspectives on Tuberculosis Treatment Barriers and Facilitators in High TB Burden Regions of Argentina.
abstract: Purpose. In Argentina, tuberculosis (TB) control measures have not achieved key treatment targets. The purpose of this study was to identify modes of treatment delivery and explore patient and healthcare personnel perceptions of barriers and facilitators to treatment success. Methods. We used semistructured group and individual interviews for this descriptive qualitative study. Eight high burden municipalities were purposively selected. Patients in treatment for active TB (n = 16), multidisciplinary TB team members (n = 26), and TB program directors (n = 12) at local, municipal, regional, and national levels were interviewed. Interviews were recorded, transcribed verbatim, and analyzed using thematic analysis. Results. Modes of treatment delivery varied across municipalities and types of healthcare facility and were highly negotiated with patients. Self-administration of treatment was common in hospital-based and some community clinics. Barriers to TB treatment success were concentrated at the system level. This level relied heavily on individual personal commitment, and many system facilitators were operating in isolation or in limited settings. Conclusions. We outline experiences and perspectives of the facilitating and challenging factors at the individual, structural, social, and organizational levels. Establishing strong patient-healthcare personnel relationships, responding to patient needs, capitalizing on community resources, and maximizing established decentralized system could mitigate some of the barriers.
authors.affiliation: School of Nursing, Columbia University, 630 West 168 Street, New York, NY 10032, USA ; Institute for Clinical Effectiveness and Healthcare Policy, Dr. Emilio Ravignani 2024, C1414CPT Buenos Aires, Argentina.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Iribarren
authors.affiliation: Institute for Clinical Effectiveness and Healthcare Policy, Dr. Emilio Ravignani 2024, C1414CPT Buenos Aires, Argentina.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rubinstein
authors.affiliation: Division of Family and Community Medicine, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH Buenos Aires, Argentina.
authors.forename: Vilda
authors.initials: V
authors.lastname: Discacciati
authors.affiliation: School of Nursing, Loyola University, 6363 Saint Charles Avenue, Stallings Hall, New Orleans, LA 70118, USA.
authors.forename: Patricia F
authors.initials: PF
authors.lastname: Pearce