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Open Access Short Report

Illness costs to households are a key barrier to access diagnostic and treatment services for tuberculosis in Tajikistan

Raffael Ayé12*, Kaspar Wyss12, Hanifa Abdualimova3 and Sadullo Saidaliev4

Author Affiliations

1 Swiss Tropical and Public Health Institute, Swiss Centre for International Health, Socinstr. 57, 4002 Basel, Switzerland

2 University of Basel, Basel, Switzerland

3 Project Sino, Rudaki prospekt proyezd 5, dom 1, Dushanbe, Tajikistan

4 Ministry of Health and Republican Centre for Tuberculosis Control, Bukhoro Street 53, Dushanbe, Tajikistan

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BMC Research Notes 2010, 3:340  doi:10.1186/1756-0500-3-340

Published: 20 December 2010

Abstract

Background

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.

Findings

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.

Conclusions

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.