Delays to TB care among Zambian mineworkers: Application of the Three-Delay Framework Public

Abstract

Setting: Mineworkers in countries with high prevalences of tuberculosis (TB) and HIV are at an increased risk for TB disease. Zambian mineworkers’ perceptions and attitudes towards TB care and treatment are underexplored to date.

Objective: This qualitative study aimed to understand mineworkers’ barriers to TB diagnosis, care, and treatment in the Copperbelt and North-Western provinces of Zambia.

Design: This was a qualitative cross-sectional study consisting of 30 focus group discussions with 271 mineworkers. The Three Delay Framework was utilized to identify themes corresponding to each delay in TB care and treatment.

Results: Fear of job loss, distrust in mine clinics, and HIV stigma contributed to delays in mineworkers’ decisions to seek care. A lack of transport and the mine supervisors’ refusal to let workers leave for medical care emerged as barriers to actually reaching healthcare facilities. Finally, mineworkers discussed a perceived lack of skilled healthcare workers, the involvement of the mining company in healthcare decisions, and a lack of follow-up care at annual exams as barriers to obtaining adequate care.

Conclusion: Mineworkers experience unique barriers to TB care and treatment. To facilitate care, partnerships between key stakeholders including mining companies and the national TB program must be formed to ensure the success of targeted interventions.

Table of Contents

EXTENDED INTRODUCTION...1

Mining in Zambia...1

Mineworkers: A Key Population...3

Zambia Assessment of TB and HIV in the Mines (ZATHIM)...4

Justification of Analysis...5

Objectives of this Analysis...5

Definition of Terms...7

LITERATURE REVIEW... 8

Tuberculosis and HIV Burden in Zambia...8

Mineworkers as a Key Population for TB & HIV Control...9

Health seeking behavior & Barriers to Care for Mineworkers...12

Health Belief Model and the Three Delay Framework...13

Synthesis...14

MANUSCRIPT...16

Summary Abstract...17

Introduction...18

Study Population and Methods...19

Results...22

Discussion...29

Conclusion...32

Table 1. Demographic data from FGD participants...34

Table 2. Primary themes...35

Table 3. Secondary themes...36

PUBLIC HEALTH IMPLICATIONS & RECOMMENDATIONS...37

REFERENCES...41

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Mot-clé	Three Delay Framework Health Belief Model Tuberculosis HIV Zambia Mineworkers
Committee Chair / Thesis Advisor	Hussen, Sophia A., Emory University
Committee Members	Podewils, Laura J. , CDC
Partnering Agencies	CDC

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