Background: Tuberculosis (TB) remains the leading cause of death in South Africa. As an infectious respiratory disease, control of TB includes antibiotic treatment over a number of months in order to cure the disease and reduce transmission to others. The need to adhere to treatment over an extended period highlights the importance of reducing access barriers to TB services. While gender related access barriers have been identified as critical in the treatment and control of other conditions such as Human Immunodeficiency Virus (HIV), no quantitative analyses currently exist that assess the gender-related dimensions of access to TB services in South Africa.
Methods: This study aims to assess the gender-based differences in access to TB services in South Africa, from the perspective of TB patients. Using a comprehensive framework where access is defined as the opportunity to use services, we interviewed 1,229 TB patients using services in four provinces of South Africa. Comparisons of access barriers and adherence between men and women were examined using multivariate linear and logistic regressions.
Results: There was no significant association between levels of adherence and gender (all p-values>0.05). Among availability-related variables, men spent significantly less time at the clinic to fetch TB medication compared with women (coefficient, -7.06; 95% CI, [-13.5, -0.7]). Regarding affordability, men were significantly less likely to receive a disability grant (AOR, 0.48; 95% CI, [0.36, 0.63]). Concerning the acceptability dimension, men were less likely to report that queues to visit a healthcare provider were too long or the cleanliness of the facility to be sub-standard (AOR, 0.69; 95% CI, [0.52, 0.91], and AOR, 0.67; 95% CI, [0.46, 0.97], respectively).
Conclusions: Our findings indicate that there is no association between the level of adherence to TB treatment and gender. Moreover, there was no evidence of systematic gender-based inequalities in access to TB services. However, the findings reveal concerns about the condition and cleanliness of health facilities that may impact the patients' adherence and be a barrier, specifically, in women's use of TB services.