BMC Health Services Research
Volume 19, Issue 1, 2019

Tuberculosis care for migrant patients in Portugal: A mixed methods study with primary healthcare providers (Article) (Open Access)

Tavares A.M.* , Garcia A.C. , Gama A. , Abecasis A.B. , Viveiros M. , Dias S.
  • a Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, Lisbon, 1349-008, Portugal
  • b Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, Lisbon, 1349-008, Portugal, Departamento de Epidemiologia, Instituto Nacional de Saúde Dr. Ricardo Jorge (INSA), Av. Padre Cruz, Lisbon, 1649-016, Portugal
  • c Escola Nacional de Saúde Pública, Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Av. Padre Cruz, Lisbon, 1600-560, Portugal
  • d Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, Lisbon, 1349-008, Portugal
  • e Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, Lisbon, 1349-008, Portugal
  • f Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, Lisbon, 1349-008, Portugal, Escola Nacional de Saúde Pública, Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Av. Padre Cruz, Lisbon, 1600-560, Portugal

Abstract

Background: Tuberculosis (TB) is still a major global health problem. The increasing number of cases observed among foreign-born populations contrasts with the decreasing trends observed in later years in some high-income countries. Healthcare providers are key interveners in the control of TB and HIV-TB infections. In this study, we aimed to explore the perspectives of healthcare providers working in primary care in Portugal about the provision of TB care for migrant patients with TB or HIV-TB co-infection. Methods: We applied a mixed-methods approach using an online survey and semi-structured interviews with primary healthcare providers. A total of 120 Portuguese healthcare providers participated in the survey, and 17 were interviewed. Survey and interview data were analysed applying descriptive statistics and thematic analysis, respectively. Results: Migrants' lack of knowledge on TB disease and its symptoms was the main reason for advanced-stage presentation of cases. Their high mobility and social isolation affect adherence to treatment. The providers also listed several barriers to migrants' access and use of TB care. The most frequently referred were limited socioeconomic resources, complex bureaucracy at the point of access and registration for healthcare services, especially for undocumented migrants, and obstacles for social protection. Providers also advocated more training initiatives on migrants' health, social and cultural contexts, on HIV and TB integrated care, and on TB scientific update for general practitioners and nurses working at primary healthcare centres. Conclusions: Future efforts should provide measures to overcome social, economic and administrative obstacles to care for TB-infected migrants, and promote regular training initiatives for national healthcare providers in order to raise awareness and facilitate better care to culturally diverse populations with TB. © 2019 The Author(s).

Author Keywords

Migrants tuberculosis HIV-TB healthcare providers Mixed methods research

Index Keywords

Health Personnel HIV Infections Human immunodeficiency virus infection Portugal health care personnel human middle aged statistics and numerical data health service Surveys and Questionnaires Humans male latent tuberculosis female tuberculosis questionnaire health services Coinfection adult migration Transients and Migrants Health Services Accessibility mixed infection health care delivery
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85064502659&doi=10.1186%2fs12913-019-4050-0&partnerID=40&md5=fe677cbbeb6ed069ec930fba3ade285f
DOI: 10.1186/s12913-019-4050-0
ISSN: 14726963
Original Language: English