Date of Award

12-7-2021

Degree Type

Thesis

Degree Name

Master of Health Policy and Management

First Advisor

Dr. Amna Rehana Siddiqui

Second Advisor

Dr. Mohammad Asim

Third Advisor

Dr. Sobia Sawani

Department

Community Health Sciences

Abstract

Background: Globally, Pakistan is ranked 5th among TB high-burden countries (HBC), with 573 000 estimated TB cases and 48% notification of the estimate cases for 2020 (276,736 cases diagnosed). According to WHO Global Tuberculosis Report 2021, the incidence of TB in the general population is 259 per 100,000 population. In the last few years, the National and Provincial TB Programs have achieved good treatment success rates (reaching 93%) among drug susceptible TB patients (DS-TB) in 2019. However, in 2020 the proportion of TB diagnosis and treatment coverage (notified/estimated incidence) has decreased by >10% respect to 2019.In 2020, Province of Sindh has an estimated TB disease burden of 0.12 million cases per year. The treatment coverage is around 60%. In the year 2020, case detection rate was around 64,892 (52%) which means that around 60,000 cases of TB were missing from Notification (48%) and they may further spread the disease. There is an increased chance that the missing TB cases might be found among key populations as notification of TB among key/marginalized population remains very inaccurate due to under reporting.
Purpose: The purpose of the present study is to estimate the prevalence of TB patients diagnosed among transgenders (TGs)/Hijras during the period of 2017-2020 and explore the barriers in accessing healthcare services on phenomenology of lived experiences of key population diagnosed with TB through In-depth interviews.
Methodology: The concurrent Mixed method study design was carried out among transgenders living in Shaheed Benazirabad district of Sindh. The study is secondary analysis of project data on Active case finding for TB among the key population whose purpose is to assess the prevalence of TB among the key/marginalized population who are unable to access quality care due to stigma and discrimination. For the Quantitative component, data were available from screening of TG population using an active case finding method during 2017-2020. A standard questionnaire for identified presumptive Tuberculosis (TB) was applied to 280 identified Transgenders in the district each year. For the qualitative component, 08 were interviewed using descriptive phenomenology which is a unique way of exploring individual lived experiences. Data were analyzed from the available in-depth transcriptions of the Transgenders who were diagnosed with TB using the modified conceptual framework of Levesque et el.
Results: For the year 2017-2020, overall, 2.2% (23 TGs) of the transgenders had TB. Among the TGs who were diagnosed with TB, 9% (n=2) were clinically diagnosed while 91% (n=21) were bacteriologically positive. The HIV positivity rate among the diagnosed TGs with TB was 17% (n=4). Out of the screened TGs, only 5% had BCG scar present. Majority of the transgenders belonged to the age bracket of 15-34 years (60%) and most of them were found to be uneducated (77%) The qualitative analysis found multifaceted barriers faced by the key population with respect to healthcare access. Among the diagnosed TB transgenders, 08 were interviewed using descriptive phenomenology exploring individual lived experience via thematic analysis to identify potential barriers experienced by the Key population (Transgender). Majority of the participants did not have knowledge on TB, were reluctant in seeking medical help, experienced inaccessibility to healthcare or availing medical care, inability to pay, discrimination, poverty and inappropriate attitude of medical personnel towards them.
Conclusion: Key population are high risk group who should be periodically be screened for TB as they have higher prevalence of TB and HIV as reported during the course of the study (2-3 %). Estimates of the burden of TB among key population and evidence of their inability to access healthcare services can enable the policy makers to focus on the case finding strategies in key population increasing the notifiable TB cases and reducing the number of missing cases and transmission of TB in key population. In addition, addressing the barriers in accessing healthcare faced by key populations for better outcomes of the TB program.

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1

Last Page

54

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