Barriers to the diagnosis and treatment of tuberculosis in Abidjan, Côte d’Ivoire: a qualitative study

Tuberculosis (TB) remains a leading cause of morbidity and mortality in West Africa. An understanding of the barriers to prompt diagnosis and treatment of TB is critical in order to develop strategies to improve TB outcomes. We conducted a qualitative sub-study within the TB-Sentinel Research Network of IeDEA at the CePReF clinic in Abidjan, Côte d’Ivoire. Individuals $$\:\ge\:$$18 years of age who had received treatment for pulmonary TB within the preceding 12 months were interviewed. Qualitative data collection and analysis were guided by the Grounded Theory approach. Interviews were conducted with 40 participants (median age 35 [IQR 25–46] years), including 19 (47.5%) women and 9 (22.5%) people living with HIV (PLHIV). Participants experienced a substantial delay between symptom onset and TB diagnosis despite the presence of active TB symptoms and persistent care seeking. They sought care a median of 3 [IQR 2–5] times before TB testing and experienced a median diagnostic delay of 4 [IQR 3–6] months between symptom onset and TB diagnosis. The patient care pathway consisted of three distinct phases: the care-seeking phase, the diagnosis phase, and the treatment phase. Seven categories emerged across the three phases, each representing a potential barrier to the diagnosis and treatment of TB: (1) delayed TB diagnosis (sub-categories: prolonged care-seeking, repeated expenditures, and turning to sorcery), (2) fear of TB, (3) TB-associated stigma (sub-category: equating TB with HIV), (4) financial distress, (5) food insecurity, (6) enduring isolation (sub-categories: psychological distress and social setbacks), and (7) adherence anxiety. To our knowledge, this is the first study to explore barriers to the diagnosis and treatment of TB in Côte d’Ivoire. Throughout each phase of the care pathway, individuals suffering from TB disease must continuously persevere in order to overcome enormous barriers. There is a need for strategies to alleviate their burden, to improve the early recognition and diagnosis of TB, and to address TB-associated stigma. Research to enhance community-based diagnostic testing, and the development and implementation of psychological support and social protection strategies, should be prioritized.