Exploring Barriers and Facilitators to Accessing TB Health Services: Perspectives of Persons with TB, Caregivers, and Health Workers Using the Levesque Framework

Background: Barriers to access to tuberculosis (TB) care are a major obstacle to achieving the national and global targets of ending the TB epidemic by 2030. We conducted a qualitative study to understand these barriers and design interventions to improve access to TB services in Uganda. Methods: We purposively selected persons on treatment for drug sensitive tuberculosis (DS-TB). We included those living with HIV and caregivers of children with TB. We carried out focus group discussions and in-depth interviews. Data was collected and analyzed deductively in line with the Lévesque framework using NVivo 12. Results: We interviewed 96 persons with drug-sensitive tuberculosis (DS-TB) and 11 caregivers of children with TB. We found barriers along all of Lévesque’s five domains of access to care among. We found insufficient knowledge about TB symptoms among respondents which hinder their ability to perceive that they need TB care services. This hindered their ability to seek appropriate care for TB symtoms instead preferring herbal medication and spiritual healing. When persons decided to seek appropriate care, long distances to health facilities hindered their ability to reach TB care services. Furthermore, the lack of money to pay for medical and non-medical costs associated with TB care e.g., transport and chest X-rays, hindered their ability to access TB care sercices. Finally, the lack of adequate numbers of healthcare workers decreases the time available for meaningful engagement with TB care services because healthcare workers do not devote adequate amounts of time to patient education and counselling. Major emerging themes among facilitators for accessing TB care included preference for community-based interventions, quality patient-health worker relationships, availability of diagnostics and free drugs, proximity to health facilities, and individual-level factors (self-motivation and reminders by treatment supporters). Conclusion: The study underscores the need for multidimensional approaches addressing individual, community and health system factors to improve access to TB care.