Perspective of Successful Tuberculosis Treatment in Argentina

Tuesday, July 12, 2011: 4:05 PM

Sarah J. Iribarren, RN
College of Nursing, University of Utah, Salt Lake City, UT
Patricia Flannery Pearce, MPH, PhD, APRN-FNP
School of Nursing, University of Alabama at Birmingham, Birmingham, AL
Fernando Rubinstein, MD, MPH
School of Public Health, Institute for Clinical Effectiveness and Health Policy. University of Buenos Aires, Buenos Aires, Argentina
Vilda Discacciati, MD
Department of Public Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina

Learning Objective 1: The learner will be able to identify treatment strategies and barriers and facilitators to successful treatment of tuberculosis from the multiple perspectives.

Learning Objective 2: The learner will be able to identify strategies in which health care centers have attempted to overcome identified barriers to TB treatment success.

Purpose: Tuberculosis (TB) remains a major public health problem globally, including in Argentina, where treatment success rates are well below WHO recommendations.  The purpose of this research was to identify treatment strategies and explore barriers/facilitators to successful treatment in a high TB burden health region in Argentina.

Methods: Descriptive qualitative research was conducted using semi-structured in-depth interviews with key TB personnel (physicians, nurses, and social workers), TB program local, regional and national directors, and patients/family members.  Participants (N=42) were from five health districts within a high TB burden Health Region in Buenos Aires, Argentina.

Results: Treatment strategies varied and were negotiated in order to maintain patients in treatment (e.g. direct observation of treatment (DOT) daily, during the week, and negotiated or personalized).  Self-administration of treatment was primarily at hospital-based clinics. Most active TB cases were treated at hospitals, rather than the local healthcare centers. A wide range of factors (N=37) classified as barriers and facilitators to TB treatment success were identified. Factors were classified into three main categories; personal (patient and healthcare personnel, e.g., lack of understanding/knowledge of TB), social (e.g., support, trust), and system or organizational factors (e.g., service availability, accessibility). Multiple examples of patient-centered care and creative strategies to overcome barriers were identified (e.g. provision of DOT without appointment and through separate door). Main themes of commitment, continuity and collaboration were identified.

Conclusion: Findings include barriers that potentially contribute to the overall persistent low rates of treatment success in Argentina.  Some of the barriers identified by patients were overcome by communication and relationships established with healthcare personnel.  DOT was described as a broader package of support in which healthcare personnel characteristics, provision of food, or other provider-patient interactions play a vital role.  Findings have implication for practice and research, including collaboration with health systems of neighboring countries.