Barriers and Delays in Tuberculosis Diagnosis and Treatment Services: Does Gender Matter?

Abstract EN

Background.

Tuberculosis (TB) remains a global public health problem with known gender-related disparities.

We reviewed the quantitative evidence for gender-related differences in accessing TB services from symptom onset to treatment initiation.

Methods.

Following a systematic review process, we: searched 12 electronic databases; included quantitative studies assessing gender differences in accessing TB diagnostic and treatment services; abstracted data; and assessed study validity.

We defined barriers and delays at the individual and provider/system levels using a conceptual framework of the TB care continuum and examined gender-related differences.

Results.

Among 13,448 articles, 137 were included: many assessed individual-level barriers (52%) and delays (42%), 76% surveyed persons presenting for care with diagnosed or suspected TB, 24% surveyed community members, and two-thirds were from African and Asian regions.

Many studies reported no gender differences.

Among studies reporting disparities, women faced greater barriers (financial: 64% versus 36%; physical: 100% versus 0%; stigma: 85% versus 15%; health literacy: 67% versus 33%; and provider-/system-level: 100% versus 0%) and longer delays (presentation to diagnosis: 45% versus 0%) than men.

Conclusions.

Many studies found no quantitative gender-related differences in barriers and delays limiting access to TB services.

When differences were identified, women experienced greater barriers and longer delays than men.