Ayé Raffael, Wyss Kaspar, Abdualimova Hanifa, Saidaliev Sadullo
Swiss Tropical and Public Health Institute, Swiss Centre for International Health, Socinstr, 57, 4002 Basel, Switzerland.
BMC Res Notes. 2010 Dec 20;3:340. doi: 10.1186/1756-0500-3-340.
Tuberculosis (TB) control is based on early detection and complete treatment of infectious cases. Consequently, it is important that TB suspects and patients can readily access medical care. This qualitative study investigated determinants of access to DOTS services as identified by patients, health providers and community members in four districts in Tajikistan.
Focus group discussions were conducted in order to investigate access to TB services. A conceptual framework for access to care guided the analysis. Thirteen focus group discussions involving a total of 97 informants were conducted. Content analysis of discussions and a rating to quantify the relative importance of discussed factors were carried out. The conceptual framework identifies five main components of access to which factors can be assigned: availability, adequacy, acceptability, accessibility and affordability.Financial factors were considered the most important determinants of access to diagnosis and treatment of tuberculosis. Expenditure for drugs and consultations, for transport, and for special foods as well as lost income were identified as major barriers to treatment. Stigma, doubts about curability and low perceived quality of care were not seen to be significant determinants of access to care for tuberculosis. Community members were well aware of symptoms of tuberculosis and of medical services. These findings were consistent between different respondent groups (community members, patients and providers). They were also highly consistent between the open discussion and the confidential rating.
Illness-costs to households were identified as the main barrier to tuberculosis diagnosis and treatment. To improve access and ultimately adherence to tuberculosis treatment, effective mitigation strategies, e.g. changes in case management, food contributions or financial stimuli, need to be explored and implemented.
结核病控制基于对感染病例的早期发现和彻底治疗。因此，结核病疑似患者和患者能够方便地获得医疗服务至关重要。这项定性研究调查了塔吉克斯坦四个地区的患者、医疗服务提供者和社区成员所确定的获得直接观察短程治疗（DOTS）服务的决定因素。
为了调查结核病服务的可及性，开展了焦点小组讨论。一个医疗服务可及性的概念框架指导了分析。共进行了13次焦点小组讨论，涉及97名受访者。对讨论内容进行了分析，并对所讨论因素的相对重要性进行了评分以量化。该概念框架确定了可及性的五个主要组成部分，可将各种因素归入其中：可得性、充分性、可接受性、可达性和可承受性。财务因素被认为是获得结核病诊断和治疗的最重要决定因素。药品和咨询、交通、特殊食品的支出以及收入损失被确定为治疗的主要障碍。耻辱感、对治愈性的怀疑以及对医疗服务质量的低认知度并未被视为获得结核病医疗服务的重要决定因素。社区成员非常了解结核病症状和医疗服务。这些发现在不同的受访者群体（社区成员、患者和医疗服务提供者）之间是一致的。在公开讨论和保密评分之间也高度一致。
家庭疾病成本被确定为结核病诊断和治疗的主要障碍。为了改善获得结核病治疗的机会并最终提高治疗依从性，需要探索和实施有效的缓解策略，例如改变病例管理、提供食品捐助或给予经济刺激。
