South Africa's TB Challenge: Persisting Legacy

Tuberculosis (TB) - an old disease that has distressed the human race for more than 4 000 years - remains a pressing public health concern (Zaman, 2010; Krishnan et al., 2014). In South Africa regardless of applying the Directly Observed Treatment, Short-Course (DOTS) strategy since 1996 and substantial investments and enhancements in TB control, the case detection rate is still far from the goals defined by the World Health Organization (WHO). With 450 000 new TB infections annually, TB is anticipated to bring many repercussions on both mortality and morbidity of South Africans along with enormous financial consequences for the health system (Foster et al., 2015; SANAC, 2017). The burden of non-adherence to TB treatment has been affirmed as one of the primary challenges facing global control of TB pandemic (Van den Boogaard et al., 2011). In a situation where non-adherence to treatment is the consequence of unjust and avoidable forces, equity issue inflates its significance. Although TB services are free at the point of use in South African public health facilities, much is unknown about overall barriers in access to TB services and their association with treatment adherence. Gender, as a social determinant of health, has been reported to impact the access and adherence to TB services in other settings, while genderrelated barriers to TB access have been an under-researched area in South Africa. This study aims to explore these barriers as well as the gender-based differences of perceived barriers from the perspective of TB patients who enrolled in DOTS in South Africa. The following section introduces the overall methodological approach to the study. It represents the study design, the study setting and data sources in addition to the methods used in data analysis."