| Autor: |
Wippel C; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts., Farroñay S; Socios En Salud Sucursal Peru, Lima, Peru., Gilbert HN; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts., Millones AK; Socios En Salud Sucursal Peru, Lima, Peru., Acosta D; Socios En Salud Sucursal Peru, Lima, Peru., Torres I; Socios En Salud Sucursal Peru, Lima, Peru., Jimenez J; Socios En Salud Sucursal Peru, Lima, Peru., Alarcón VA; Dirección de Prevención y Control de la Tuberculosis, Ministry of Health, Lima, Peru., Lecca L; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.; Socios En Salud Sucursal Peru, Lima, Peru., Yuen CM; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts. |
| Abstrakt: |
In Latin America, little is known about the involvement of private health-care providers in tuberculosis (TB) detection and management. We sought to gain a better understanding of current and potential roles of the private sector in delivering TB services in Peru. We conducted a mixed-methods study in North Lima, Peru. The quantitative component comprised a patient pathway analysis assessing the alignment of TB services with patient care-seeking behavior. The qualitative component comprised in-depth interviews with 18 private health-care providers and 5 key informants. We estimated that 77% of patients sought care initially at a facility with TB diagnostic capacity and 59% at a facility with TB treatment capacity. Among private facilities, 43% offered smear microscopy, 13% offered radiography, and none provided TB treatment. Among public-sector facilities, 100% offered smear microscopy, 26% offered radiography, and 99% provided TB treatment. Private providers believed they offered shorter wait times and a faster diagnosis, but they struggled with a lack of referral systems and communication with the public sector. Nonrecognition of private-sector tests by the public sector led to duplicate testing of referred patients. Although expressing willingness to collaborate with public-sector programs for diagnosis and referral, private providers had limited interest in treating TB. This study highlights the role of private providers in Peru as an entry point for TB care. Public-private collaboration is necessary to harness the potential of the private sector as an ally for early diagnosis. |
