Barriers and facilitators to accessing tuberculosis care in Nepal: a qualitative study to inform the design of a socioeconomic support intervention

Dixit, Kritika, Biermann, Olivia, Rai, Bhola, Aryal, Tara Prasad, Mishra, Gokul, Teixeira de Siqueira-Filha, Noemia, Paudel, Puskar Raj, Pandit, Ram Narayan, Sah, Manoj Kumar, Majhi, Govinda, Levy, Jens, Rest, Job van, Gurung, Suman Chandra, Dhital, Raghu, Lönnroth, Knut, Squire, Bertie ORCID: https://orcid.org/0000-0001-7173-9038, Caws, Maxine ORCID: https://orcid.org/0000-0002-9109-350X, Sidney, Kristi and Wingfield, Tom ORCID: https://orcid.org/0000-0001-8433-6887 (2021) 'Barriers and facilitators to accessing tuberculosis care in Nepal: a qualitative study to inform the design of a socioeconomic support intervention'. BMJ open, Vol 11, Issue 10, e049900.

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Abstract

OBJECTIVE

Psychosocial and economic (socioeconomic) barriers, including poverty, stigma and catastrophic costs, impede access to tuberculosis (TB) services in low-income countries. We aimed to characterise the socioeconomic barriers and facilitators of accessing TB services in Nepal to inform the design of a locally appropriate socioeconomic support intervention for TB-affected households.

DESIGN

From August 2018 to July 2019, we conducted an exploratory qualitative study consisting of semistructured focus group discussions (FGDs) with purposively selected multisectoral stakeholders. The data were managed in NVivo V.12, coded by consensus and analysed thematically.

SETTING

The study was conducted in four districts, Makwanpur, Chitwan, Dhanusha and Mahottari, which have a high prevalence of poverty and TB.

PARTICIPANTS

Seven FGDs were conducted with 54 in-country stakeholders, grouped by stakeholders, including people with TB (n=21), community stakeholders (n=13) and multidisciplinary TB healthcare professionals (n=20) from the National TB Programme.

RESULTS

The perceived socioeconomic barriers to accessing TB services were: inadequate TB knowledge and advocacy; high food and transportation costs; income loss and stigma. The perceived facilitators to accessing TB care and services were: enhanced championing and awareness-raising about TB and TB services; social protection including health insurance; cash, vouchers and/or nutritional allowance to cover food and travel costs; and psychosocial support and counselling integrated with existing adherence counselling from the National TB Programme.

CONCLUSION

These results suggest that support interventions that integrate TB education, psychosocial counselling and expand on existing cash transfer schemes would be locally appropriate and could address the socioeconomic barriers to accessing and engaging with TB services faced by TB-affected households in Nepal. The findings have been used to inform the design of a socioeconomic support intervention for TB-affected households. The acceptability, feasibility and impact of this intervention on TB-related costs, stigma and TB treatment outcomes, is now being evaluated in a pilot implementation study in Nepal.

Item Type:	Article
Subjects:	W General Medicine. Health Professions > W 74 Medical economics. Health care costs WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General) WF Respiratory System > Tuberculosis > WF 310 Therapy
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1136/bmjopen-2021-049900
Depositing User:	Julie Franco
Date Deposited:	23 Nov 2021 14:10
Last Modified:	23 Nov 2021 14:10
URI:	https://archive.lstmed.ac.uk/id/eprint/19487

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