ArticleBMJ open2021
Barriers and facilitators to accessing tuberculosis care in Nepal: a qualitative study to inform the design of a socioeconomic support intervention.
Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 1 of them a synthesis that pooled it.
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Who cites it
25 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Urban and rural prevalence of tuberculosis in low- and middle-income countries: A systematic review and meta-analysis.PLoS medicine · 2026Pooled it
- Drivers of drug-resistant tuberculosis treatment initiation delay at three tertiary health facilities in Uganda: A mixed-methods study.Journal of clinical tuberculosis and other mycobacterial diseases · 2026Article
- Epidemiological trajectories and predictive modeling of latent tuberculosis prevalence in South Asia: an in-depth global burden of disease analysis (1990-2021) with advanced forecasting to 2050.Journal of clinical tuberculosis and other mycobacterial diseases · 2026Article
- Multilevel Determinants of Tuberculosis Treatment Interruption in Rural South Africa: Insights from Primary Healthcare Nurses.International journal of environmental research and public health · 2026Article
- Community willingness towards a hypothetical new TB vaccine: a qualitative study to explore the enablers and barriers for vaccine acceptability in Nepal.BMJ public health · 2026Article
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- Barriers and facilitators to tuberculosis service access for patients in Bajhang, Nepal: a qualitative study based on focus groups with patients, screening camp visitors, community volunteers and medical doctors.Journal of health, population, and nutrition · 2025Article
- Patient and health system delays in the diagnosis and treatment of tuberculosis in Gandaki, Nepal.PLOS global public health · 2025Article
- Healthcare providers' and community stakeholders' perception of using drones for tuberculosis diagnosis in Nepal: an exploratory qualitative study.BMC health services research · 2024Article
- Community-based psychosocial support interventions to reduce stigma and improve mental health of people with infectious diseases: a scoping review.Infectious diseases of poverty · 2024Article
- Investigating socio-ecological factors influencing implementation of tuberculosis infection prevention and control in rural Papua New Guinea.Journal of public health (Oxford, England) · 2024Article
- Tuberculosis treatment delay and associated factors among pulmonary tuberculosis patients at public health facilities in Dale District and Yirgalem Town administration, Sidama Region, South Ethiopia.BMC infectious diseases · 2024Article
- Need for operational simplicity and timely disbursal of benefits-a qualitative exploration of the implementation of a direct benefit transfer scheme for persons with tuberculosis in India.Infectious diseases of poverty · 2024Article
- Stigma, depression, and quality of life among people with pulmonary tuberculosis diagnosed through active and passive case finding in Nepal: a prospective cohort study.BMC global and public health · 2024Article
- Ending tuberculosis: challenges and opportunities.Frontiers in tuberculosis · 2024Review
- Determinants of catastrophic costs among households affected by multi-drug resistant tuberculosis in Ho Chi Minh City, Viet Nam: a prospective cohort study.BMC public health · 2023Article
- Comparing cross-sectional and longitudinal approaches to tuberculosis patient cost surveys using Nepalese data.Health policy and planning · 2023Article
- Comparing Additionality of Tuberculosis Cases Using GeneXpert or Smear-Based Active TB Case-Finding Strategies among Social Contacts of Index Cases in Nepal.Tropical medicine and infectious disease · 2023Article
- Barriers to and facilitators of populational adherence to prevention and control measures of COVID-19 and other respiratory infectious diseases: a qualitative evidence synthesis.European respiratory review : an official journal of the European Respiratory Society · 2023Review
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Authors and funding
19 authors.
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Abstract
objectivePsychosocial and economic (socioeconomic) barriers, including poverty, stigma and catastrophic costs, impede access to tuberculosis (TB) services in low-income countries. We aimed to characterise the socioeconomic barriers and facilitators of accessing TB services in Nepal to inform the design of a locally appropriate socioeconomic support intervention for TB-affected households.
designFrom August 2018 to July 2019, we conducted an exploratory qualitative study consisting of semistructured focus group discussions (FGDs) with purposively selected multisectoral stakeholders. The data were managed in NVivo V.12, coded by consensus and analysed thematically.
settingThe study was conducted in four districts, Makwanpur, Chitwan, Dhanusha and Mahottari, which have a high prevalence of poverty and TB.
participantsSeven FGDs were conducted with 54 in-country stakeholders, grouped by stakeholders, including people with TB (n=21), community stakeholders (n=13) and multidisciplinary TB healthcare professionals (n=20) from the National TB Programme.
resultsThe perceived socioeconomic barriers to accessing TB services were: inadequate TB knowledge and advocacy; high food and transportation costs; income loss and stigma. The perceived facilitators to accessing TB care and services were: enhanced championing and awareness-raising about TB and TB services; social protection including health insurance; cash, vouchers and/or nutritional allowance to cover food and travel costs; and psychosocial support and counselling integrated with existing adherence counselling from the National TB Programme.
conclusionThese results suggest that support interventions that integrate TB education, psychosocial counselling and expand on existing cash transfer schemes would be locally appropriate and could address the socioeconomic barriers to accessing and engaging with TB services faced by TB-affected households in Nepal. The findings have been used to inform the design of a socioeconomic support intervention for TB-affected households. The acceptability, feasibility and impact of this intervention on TB-related costs, stigma and TB treatment outcomes, is now being evaluated in a pilot implementation study in Nepal.
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