<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0120-4157</journal-id>
<journal-title><![CDATA[Biomédica]]></journal-title>
<abbrev-journal-title><![CDATA[Biomed.]]></abbrev-journal-title>
<issn>0120-4157</issn>
<publisher>
<publisher-name><![CDATA[Instituto Nacional de Salud]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0120-41572022000200315</article-id>
<article-id pub-id-type="doi">10.7705/biomedica.6368</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Factores que afectan la cobertura del programa de tuberculosis en el primer nivel de atención en Honduras]]></article-title>
<article-title xml:lang="en"><![CDATA[Factors affecting the tuberculosis program coverage at the first level of care in Honduras]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Beltrán]]></surname>
<given-names><![CDATA[Briana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Benjumea-Bedoya]]></surname>
<given-names><![CDATA[Dione]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Alger]]></surname>
<given-names><![CDATA[Jackeline]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de Antioquia Facultad Nacional de Salud Pública Grupo de Epidemiología]]></institution>
<addr-line><![CDATA[Medellín ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Colegio Médico de Honduras Centro Nacional de Educación Médica Continua ]]></institution>
<addr-line><![CDATA[Tegucigalpa ]]></addr-line>
<country>Honduras</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Corporación Universitaria Remington Facultad de Ciencias de la Salud Grupo de Investigación en Salud Familiar y Comunitaria]]></institution>
<addr-line><![CDATA[Medellín ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Universidad Nacional Autónoma de Honduras Facultad de Ciencias Médicas Unidad de Investigación Científica]]></institution>
<addr-line><![CDATA[Tegucigalpa ]]></addr-line>
<country>Honduras</country>
</aff>
<aff id="Af5">
<institution><![CDATA[,Hospital Escuela, Tegucigalpa Departamento de Laboratorio Clínico ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Honduras</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>06</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>06</month>
<year>2022</year>
</pub-date>
<volume>42</volume>
<numero>2</numero>
<fpage>315</fpage>
<lpage>328</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_arttext&amp;pid=S0120-41572022000200315&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_abstract&amp;pid=S0120-41572022000200315&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_pdf&amp;pid=S0120-41572022000200315&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Introducción. Hay consenso global en que el diagnóstico y el tratamiento precoces de la tuberculosis pueden acelerar su control y mitigar sus consecuencias. En Honduras, la tasa de mortalidad por la enfermedad aumentó gradualmente entre 2014 y 2018, a lo que se suman las reformas en el sistema de salud del 2014 y la implementación parcial de la estrategia &#8220;Fin a la TB&#8221;.  Objetivo. Analizar las barreras y los elementos facilitadores del diagnóstico y el tratamiento que afectan la cobertura del programa nacional de tuberculosis, con el fin de brindar herramientas para la implementación efectiva de la estrategia &#8220;Fin a la TB&#8221; en San Pedro Sula, Honduras, 2015-2019.  Materiales y métodos. Se hizo un estudio mixto secuencial y explicativo de pacientes mayores de 18 años con tuberculosis pulmonar positivos en la baciloscopia. Se revisaron las fichas de notificación de la enfermedad y las historias clínicas en dos establecimientos de salud de primer nivel y se hicieron entrevistas semiestructuradas al personal de salud, los pacientes y los familiares.  Resultados. En el 74,6 % (297/398) de los casos no hubo diagnóstico oportuno. En este grupo, se encontró una mayor proporción de hombres (62,3 %; 185/297) y de adultos (80,8 %; 240/297); predominó un nivel de escolaridad inferior a la secundaria (53,7 %; 108/297); el 49,2 % (123/297) de los pacientes tenía alguna ocupación, y el 98,2 % había recibido tratamiento oportuno. Se detectaron las siguientes barreras: condiciones socioeconómicas precarias, desarticulación del sistema de salud público y privado, y límites fronterizos entre maras y pandillas. Los elementos facilitadores fueron la buena atención y la actitud del personal de salud, y la disponibilidad y reserva de tratamiento.  Conclusiones. La falta de oportunidad en el diagnóstico de tuberculosis afectó la cobertura del programa nacional como resultado de las barreras culturales y de atención en salud.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction: There is a global consensus that early diagnosis and treatment of tuberculosis (TB) can accelerate its control and mitigate its consequences. The gradual increase in the TB mortality rate from 2014 to 2018 in Honduras, the reform of the health system in 2014, and the partial implementation of the &#8220;End TB&#8221; strategy motivated this study.  Objective: To analyze barriers to and facilitators of diagnosis and treatment affecting the national TB program coverage using data from 2015 to 2019 and provide tools for the effective implementation of the &#8220;End TB&#8221; strategy in San Pedro Sula, Honduras.  Materials and methods: This was an explanatory sequential mixed-methods study on smear-positive pulmonary TB patients older than 18 years of age. TB notification sheets and medical records from two primary health care facilities were reviewed. Semistructured interviews were conducted with health care providers, patients, and their families.  Results: A total of 74.6% of the cases (297/398) did not receive a timely diagnosis; 62.3% (185/297) were men, 80.8% (240/297) were adults, 53.7% (108/297) had less than high school education, 49.2% (123/297) had some occupation, and 98.2% of participants received timely treatment. Identified barriers included low socioeconomic conditions, lack of coordination between public and private health systems, and boundaries set by gangs. Identified facilitators included good care and attitude of the health care personnel and the availability of medications.  Conclusions: The lack of opportunity to diagnose the disease affected the coverage of the national TB program due to cultural and health care barriers.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[tuberculosis]]></kwd>
<kwd lng="es"><![CDATA[accesibilidad a los servicios de salud]]></kwd>
<kwd lng="es"><![CDATA[actitud del personal de salud]]></kwd>
<kwd lng="es"><![CDATA[barreras de acceso a los servicios de salud]]></kwd>
<kwd lng="es"><![CDATA[tuberculosis pulmonar]]></kwd>
<kwd lng="es"><![CDATA[Honduras]]></kwd>
<kwd lng="en"><![CDATA[Tuberculosis]]></kwd>
<kwd lng="en"><![CDATA[health services accessibility]]></kwd>
<kwd lng="en"><![CDATA[attitude of health personnel]]></kwd>
<kwd lng="en"><![CDATA[barriers to access to health services]]></kwd>
<kwd lng="en"><![CDATA[tuberculosis, pulmonary]]></kwd>
<kwd lng="en"><![CDATA[Honduras]]></kwd>
</kwd-group>
</article-meta>
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