A mixed methods study on men's and women's tuberculosis care journeys in Lusaka, Zambia-Implications for gender-tailored tuberculosis health promotion and case finding strategies.

Autor:	Kerkhoff AD; Division of HIV, Infectious Diseases and Global Medicine Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, California, United States of America., Mwamba C; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia., Pry JM; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Division of Epidemiology, University of California Davis, Davis, California, United States of America., Kagujje M; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia., Nyangu S; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia., Mateyo K; Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia., Sanjase N; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia., Chilukutu L; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia., Christopoulos KA; Division of HIV, Infectious Diseases and Global Medicine Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, California, United States of America., Muyoyeta M; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia., Sharma A; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2023 Jun 16; Vol. 3 (6), pp. e0001372. Date of Electronic Publication: 2023 Jun 16 (Print Publication: 2023).
DOI:	10.1371/journal.pgph.0001372
Abstrakt:	Men and women with undiagnosed tuberculosis (TB) in high burden countries may have differential factors influencing their healthcare seeking behaviors and access to TB services, which can result in delayed diagnoses and increase TB-related morbidity and mortality. A convergent, parallel, mixed-methods study design was used to explore and evaluate TB care engagement among adults (≥18 years) with newly diagnosed, microbiologically-confirmed TB attending three public health facilities in Lusaka, Zambia. Quantitative structured surveys characterized the TB care pathway (time to initial care-seeking, diagnosis, and treatment initiation) and collected information on factors influencing care engagement. Multinomial multivariable logistic regression was used to determine predicted probabilities of TB health-seeking behaviors and determinants of care engagement. Qualitative in-depth interviews (IDIs; n = 20) were conducted and analyzed using a hybrid approach to identify barriers and facilitators to TB care engagement by gender. Overall, 400 TB patients completed a structured survey, of which 275 (68.8%) and 125 (31.3%) were men and women, respectively. Men were more likely to be unmarried (39.3% and 27.2%), have a higher median daily income (50 and 30 Zambian Kwacha [ZMW]), alcohol use disorder (70.9% [AUDIT-C score ≥4] and 31.2% [AUDIT-C score ≥3]), and a history of smoking (63.3% and 8.8%), while women were more likely to be religious (96.8% and 70.8%) and living with HIV (70.4% and 36.0%). After adjusting for potential confounders, the probability of delayed health-seeking ≥4 weeks after symptom onset did not differ significantly by gender (44.0% and 36.2%, p = 0.14). While the top reasons for delayed healthcare-seeking were largely similar by gender, men were more likely to report initially perceiving their symptoms as not being serious (94.8% and 78.7%, p = 0.032), while women were more likely to report not knowing the symptoms of TB before their diagnosis (89.5% and 74.4%; p = 0.007) and having a prior bad healthcare experience (26.4% and 9.9%; p = 0.036). Notably, women had a higher probability of receiving TB diagnosis ≥2 weeks after initial healthcare seeking (56.5% and 41.0%, p = 0.007). While men and women reported similar acceptability of health-information sources, they emphasized different trusted messengers. Also, men had a higher adjusted probability of stating that no one influenced their health-related decision making (37.9% and 28.3%, p = 0.001). In IDIs, men recommended TB testing sites at convenient community locations, while women endorsed an incentivized, peer-based, case-finding approach. Sensitization and TB testing strategies at bars and churches were highlighted as promising approaches to reach men and women, respectively. This mixed-methods study found important differences between men and women with TB in Zambia. These differences suggest the need for gender-tailored TB health promotion, including addressing harmful alcohol use and smoking among men, and sensitizing HCWs to prolonged delays in TB diagnosis among women, and also using gender-specific approaches as part of community-based, active case-finding strategies to improve TB diagnosis in high burden settings. Competing Interests: The authors have read the journal’s policy and have the following competing interests: ADK is an Academic Editor for PLOS Global Public Health. JMP is a guest editor for PLOS Global Public Health. KAC has received investigator-initiated research support from and served as a medical advisory board member for Gilead Sciences outside of the submitted work. This does not alter our adherence to PLOS ONE policies on sharing data and materials. (Copyright: © 2023 Kerkhoff et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze:	MEDLINE
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