# Understanding and addressing geographic barriers to accessing TB services in a high-burden urban setting

> **NIH NIH R01** · BOSTON UNIVERSITY MEDICAL CAMPUS · 2024 · $572,061

## Abstract

SUMMARY
Each year, over 10 million people become sick with tuberculosis (TB), and around 1.4 million die from the
disease. Around 86% of people with TB live in middle-income countries, with a large proportion living in cities.
To substantially decrease the global burden of TB, it is necessary to ensure that people are diagnosed quickly
and treated successfully. Geographic barriers to accessing health services – such as living far from a health
center – can lead to poor health outcomes. However, there is limited knowledge about how geographic access
barriers impact TB diagnosis and treatment outcomes in middle-income country urban settings. Health facilities
are generally present in these settings, but people with TB, who are often socially and economically
disadvantaged, face barriers in accessing them. We also lack tools for designing and targeting interventions
that address access barriers and thus improve TB diagnosis and treatment. This proposal seeks to address
these knowledge gaps using the “5 A’s” conceptual framework, which describes five domains that drive health
care access: availability, accessibility, accommodation, affordability, acceptability. To help understand how
geographic accessibility barriers and other types of access barriers contribute to delayed TB diagnosis, we will
apply structural equation modeling and simulation methods to data from TB patient surveys based on the 5 A’s
framework. To help programs target interventions to communities that are most at risk for delayed TB
diagnosis and incomplete TB treatment, we will create community-level risk scores that incorporate measures
of geographic accessibility as well as socioeconomic and demographic census data. To help programs develop
effective treatment support interventions, we will conduct a discrete choice experiment to identify optimal
packages of interventions aimed at addressing different types of access barriers during treatment, assessing
how preferences differ among different demographic groups. This proposal is significant because the results
will help TB programs to identify interventions that would be most effective for improving TB diagnosis and
treatment, and target these interventions to the individuals and communities that need them most. This
proposal is innovative because prior quantitative TB research studies have not used a health care access
conceptual framework, structural equation modeling or conjoint analysis to understand how to address access
barriers, or community risk scores to target interventions. In the long term, this research will help TB programs
reduce delays to diagnosis and incomplete treatment rates, thus reducing the global burden of TB morbidity
and mortality.

## Key facts

- **NIH application ID:** 10772172
- **Project number:** 5R01AI168424-02
- **Recipient organization:** BOSTON UNIVERSITY MEDICAL CAMPUS
- **Principal Investigator:** Helen E. Jenkins
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $572,061
- **Award type:** 5
- **Project period:** 2023-02-01 → 2028-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10772172

## Citation

> US National Institutes of Health, RePORTER application 10772172, Understanding and addressing geographic barriers to accessing TB services in a high-burden urban setting (5R01AI168424-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10772172. Licensed CC0.

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