Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia; Centro Nacional de Educación Médica Continua, Colegio Médico de Honduras, Tegucigalpa, Honduras.
Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia; Grupo de Investigación en Salud Familiar y Comunitaria, Facultad de Ciencias de la Salud, Corporación Universitaria Remington, Medellín, Colombia.
Biomedica. 2022 Jun 1;42(2):315-328. doi: 10.7705/biomedica.6368.
There is a global consensus that early diagnosis and treatment of tuberculosis (TB) can accelerate its control and mitigate its consequences. The gradual increase in the TB mortality rate from 2014 to 2018 in Honduras, the reform of the health system in 2014, and the partial implementation of the “End TB” strategy motivated this study.
To analyze barriers to and facilitators of diagnosis and treatment affecting the national TB program coverage using data from 2015 to 2019 and provide tools for the effective implementation of the “End TB” strategy in San Pedro Sula, Honduras.
This was an explanatory sequential mixed-methods study on smear-positive pulmonary TB patients older than 18 years of age. TB notification sheets and medical records from two primary health care facilities were reviewed. Semistructured interviews were conducted with health care providers, patients, and their families.
A total of 74.6% of the cases (297/398) did not receive a timely diagnosis; 62.3% (185/297) were men, 80.8% (240/297) were adults, 53.7% (108/297) had less than high school education, 49.2% (123/297) had some occupation, and 98.2% of participants received timely treatment. Identified barriers included low socioeconomic conditions, lack of coordination between public and private health systems, and boundaries set by gangs. Identified facilitators included good care and attitude of the health care personnel and the availability of medications.
The lack of opportunity to diagnose the disease affected the coverage of the national TB program due to cultural and health care barriers.
全球共识认为，早期诊断和治疗结核病（TB）可以加速其控制并减轻其后果。洪都拉斯的 TB 死亡率从 2014 年到 2018 年逐渐上升，2014 年进行了医疗体系改革，并且部分实施了“终止结核病”战略，这些因素促使本研究开展。
利用 2015 年至 2019 年的数据，分析影响国家结核病规划覆盖率的诊断和治疗障碍和促进因素，并为在洪都拉斯圣佩德罗苏拉有效实施“终止结核病”战略提供工具。
这是一项关于年龄在 18 岁以上的痰涂片阳性肺结核患者的解释性序贯混合方法研究。审查了两家初级保健机构的结核病通知表和病历。对卫生保健提供者、患者及其家属进行了半结构化访谈。
总共 74.6%（297/398）的病例未及时得到诊断；62.3%（185/297）为男性，80.8%（240/297）为成年人，53.7%（108/297）受教育程度低于高中，49.2%（123/297）有某种职业，98.2%的参与者得到了及时的治疗。确定的障碍包括社会经济条件低下、公共和私营卫生系统之间缺乏协调以及帮派设定的界限。确定的促进因素包括卫生保健人员良好的护理和态度以及药物的供应。
由于文化和卫生保健障碍，无法有机会诊断疾病，这影响了国家结核病规划的覆盖范围。
