Care for adolescents with drug-susceptible pulmonary tuberculosis in Lima, Peru: a qualitative assessment

Objective To identify the barriers and facilitators of adolescent-friendly tuberculosis (TB) services among adolescents with drug-susceptible TB (DS-TB), as defined by the WHO's Adolescent-Friendly Services (AFS) framework, in Lima, Peru. Design We conducted in-depth interviews using semistructured interview guides. Data were analysed using the framework method, in which themes were mapped onto four of the five dimensions of care in the WHO's AFS framework: accessibility, acceptability, appropriateness and effectiveness. Setting 32 public health centres operated by the Peruvian Ministry of Health in Lima from August 2018 to May 2019. Participants In-depth interviews were conducted with 34 adolescents who completed or were lost to follow-up from treatment for DS pulmonary TB disease in the preceding 12 months, their primary caregiver during treatment and 15 nurses or nurse technicians who had at least 6 months of experience supervising TB treatment. Results We found significant barriers to adolescent-friendly TB care, including facility-based directly observed therapy, lack of functioning X-ray machines, staffing shortage of psychologists and nutritionists and inadequate educational support. However, several facilitators of adolescent-friendly care were identified: free TB care, convenient locations of health centres and strong emotional support from providers. Conclusion Improvements are needed to make TB care in Lima more accessible, acceptable, appropriate and effective for adolescents, a population with unique needs. The WHO AFS framework is a useful tool to examine the quality of TB services for adolescents.