title: Barriers to the treatment of childhood tuberculous infection and tuberculosis disease: a qualitative study.
abstract: In 2012, Peru's National TB Program (NTP) reported approximately 2400 incident cases of tuberculosis (TB) disease in children aged <15 years. Peru's TB burden is concentrated in the Lima metropolitan area, particularly in poor districts such as El Agustino and La Victoria, where this study was conducted.
  
  
  
  To identify barriers to the treatment of childhood tuberculous infection and TB disease in Lima from the perspective of front-line providers and patients' families.
  
  
  
  We conducted 10 semi-structured focus groups with 53 purposefully sampled primary care providers, community health workers, and parents/guardians of pediatric TB patients. We also completed nine in-depth interviews with National TB Program administrators and pulmonologists specializing in TB. Two authors performed inductive thematic analysis and identified emerging themes.
  
  
  
  Four main treatment barriers emerged from the data: 1) dosing errors, 2) time- and labor-intensive preparation and administration of medications, 3) provider concern that isoniazid preventive therapy (IPT) generates isoniazid resistance, and 4) poor adherence to IPT.
  
  
  
  Our findings highlight the urgent need for child-friendly formulations, provider and parent/guardian education about IPT, and strategies to promote adherence to IPT, including support and supervision by health workers and/or regimens with fewer doses.
authors.affiliation: Department of Pediatrics, Alpert Medical School, Brown University, Providence, Rhode Island, USA; Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Chiang
authors.affiliation: Department of Health Care Quality, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: S
authors.initials: S
authors.lastname: Roche
authors.affiliation: Socios En Salud (Partners In Health), Lima, Peru.
authors.forename: C
authors.initials: C
authors.lastname: Contreras
authors.affiliation: Instituto Nacional de Salud del Niño, Lima, Peru.
authors.forename: H
authors.initials: H
authors.lastname: Del Castillo
authors.affiliation: Instituto Nacional de Salud del Niño, Lima, Peru.
authors.forename: P
authors.initials: P
authors.lastname: Canales
authors.affiliation: Socios En Salud (Partners In Health), Lima, Peru.
authors.forename: J
authors.initials: J
authors.lastname: Jimenez
authors.affiliation: Socios En Salud (Partners In Health), Lima, Peru.
authors.forename: K
authors.initials: K
authors.lastname: Tintaya
authors.affiliation: Socios En Salud (Partners In Health), Lima, Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Becerra
authors.affiliation: Socios En Salud (Partners In Health), Lima, Peru.
authors.forename: L
authors.initials: L
authors.lastname: Lecca
mesh_terms: D000293:Adolescent; D000995:Antitubercular Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003150:Community Health Workers; D024881:Drug Resistance, Bacterial; D005260:Female; D017144:Focus Groups; D006801:Humans; D007538:Isoniazid / Q000008:administration & dosage*; D008297:Male; D055118:Medication Adherence; D008508:Medication Errors; D009313:National Health Programs; D010290:Parents; D010568:Peru; D011320:Primary Health Care; D014376:Tuberculosis / Q000188:drug therapy*
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid