General Knowledge and Attitudes towards Tuberculosis in Patients Attending a Free Clinic in Tijuana's Zona Norte: Understanding Barriers for Seeking Medical Care

Introduction: Accounting for tuberculosis (TB), Mexico is considered a moderate incidence country, but regional rates, particularly along the United States-Mexico border are much higher. California and Baja California have the highest TB incidence rates of all the border states in their respective countries. Clearly patient’s general knowledge about tuberculosis, perspective, attitudes and socio-economic and cultural environment are important considerations for test seeking behaviors. The population attending the Health Frontiers in Tijuana student-run free-clinic (HFiT) mainly consists of deportees, substance users, sex workers, and homeless individuals who may have delayed TB diagnosis and experience barriers to access healthcare services, that is why the goal of this study is to determine the general knowledge about tuberculosis in this population.

Methods: A cross-sectional study was conducted where 178 participants were interviewed during a 6-month period. The questionnaire included sociodemographics, employment, income, SES, history of migration and drug use, prevalence of tuberculosis-like symptoms and barriers for accessing medical care. Participants were eligible if they were over eighteen years old and were seeking services at HFiT, which includes: medical consult, mental health, syringe exchange program and HIV/STD testing.

Results: A total of 178 participants were recruited, 95 (53.1%) male and 80 (44.7% female), median age was 43 years. 102 participants (57.3%) reported lifetime drug use at least once, 45 self-identified as injection drug users. Living conditions among participants are unstable: 29.2% are unemployed, 7.4% are homeless and 44.9% were deported at least once from the United States. We Identified 15 participants with symptoms suggestive of TB disease (chronic cough or hemoptysis with presence of 1 other symptom) which accounts for 8.4% of the sample. Women were found to be at lower risk for reporting TB symptoms (odds ratio (OR)=  .389, 95% confidence interval (CI)= .127 – 1.190), (p=0.88) . TB Knowledge among participants was generally correct as 75.8% of the participants knew tuberculosis is curable, 60.1% knew there is a latent form of TB. However knowledge about TB transmission is deficient as 74.2% believed tuberculosis is contagious by sharing dishes or toothbrush.

Conclusions: These findings suggest that general TB knowledge is adequate, but there is stigma in the general population about the disease. The population that attend HFiT share risk factors for TB (low SES, homeless, drug use). Findings can be used to improve public health programs for TB screening in Tijuana.