{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T18:55:10Z","timestamp":1792090510302,"version":"4.4.0"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,11,7]],"date-time":"2018-11-07T00:00:00Z","timestamp":1541548800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100009776","name":"McMaster University","doi-asserted-by":"publisher","award":["VIsion 2020 fund"],"award-info":[{"award-number":["VIsion 2020 fund"]}],"id":[{"id":"10.13039\/100009776","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Planning &amp; Management"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Eliminating tuberculosis (TB) in low\u2010incidence countries is an important global health priority, and Canada has committed to achieve this goal. The elimination of TB in low\u2010incidence countries requires effective management and treatment of latent tuberculosis infection (LTBI). This study aimed to understand and describe the system\u2010level barriers to LTBI treatment for immigrant populations in the Greater Toronto and Hamilton Area, Ontario, Canada.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A qualitative study that used purposive sampling to recruit and interview health system advisors and planners (n\u00a0=\u00a010), providers (n\u00a0=\u00a013), and clients of LTBI health services (n\u00a0=\u00a09). Data were recorded, transcribed verbatim, and analyzed using content analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Low prioritization of LTBI was an overarching theme that impacted four dimensions of LTBI care: management, service delivery, health literacy, and health care access. These factors explained, in part, inequities in the system that were linked to variations in health care quality and health care access. While some planners and providers at the local level were attempting to prioritize LTBI care, there was no clear pathway for information sharing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This multiperspective study identified barriers beyond the typical socioeconomic determinants and highlighted important upstream factors that hinder treatment initiation and adherence. Addressing these factors is critical if Canada is to meet the WHO's global call to eradicate TB in all low incidence settings.<\/jats:p><\/jats:sec>","DOI":"10.1002\/hpm.2670","type":"journal-article","created":{"date-parts":[[2018,11,7]],"date-time":"2018-11-07T09:25:09Z","timestamp":1541582709000},"page":"384-395","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Low prioritization of latent tuberculosis infection\u2014<scp>A<\/scp> systemic barrier to tuberculosis control: <scp>A<\/scp> qualitative study in <scp>O<\/scp>ntario, <scp>C<\/scp>anada"],"prefix":"10.1002","volume":"34","author":[{"given":"Deborah A.","family":"Milinkovic","sequence":"first","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact McMaster University  Hamilton Canada"},{"name":"Centre for Health Economics and Policy Analysis McMaster University  Hamilton Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1372-0440","authenticated-orcid":false,"given":"Stephen","family":"Birch","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact McMaster University  Hamilton Canada"},{"name":"Centre for the Business and Economics of Health University of Queensland  Brisbane Australia"},{"name":"Centre for Health Economics University of Manchester  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2704-5554","authenticated-orcid":false,"given":"Fran","family":"Scott","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact McMaster University  Hamilton Canada"},{"name":"Centre for Health Economics and Policy Analysis McMaster University  Hamilton Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6441-7863","authenticated-orcid":false,"given":"K. Bruce","family":"Newbold","sequence":"additional","affiliation":[{"name":"School of Geography and Earth Sciences (SGES) McMaster University  Hamilton Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Hopkins","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact McMaster University  Hamilton Canada"},{"name":"Region of Peel Public Health  Mississauga Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muntasir","family":"Saffie","sequence":"additional","affiliation":[{"name":"Division of Respirology McMaster University  Hamilton Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1512-4634","authenticated-orcid":false,"given":"Beverley M.","family":"Essue","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact McMaster University  Hamilton Canada"},{"name":"Centre for Health Economics and Policy Analysis McMaster University  Hamilton Canada"},{"name":"Menzies Centre for Health Policy University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,11,7]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"Canadian Tuberculosis Standards","author":"Public Health Agency of Canada","year":"2014"},{"key":"e_1_2_7_3_1","volume-title":"Tuberculosis in Canada 2012","author":"Public Health Agency of Canada","year":"2015"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.090302"},{"issue":"11","key":"e_1_2_7_5_1","first-page":"1235","article-title":"Adherence to treatment for latent tuberculosis infection: systematic review of studies in the US and Canada","volume":"12","author":"Hirsch\u2010Moverman Y","year":"2008","journal-title":"Int J Tuberc Lung Dis"},{"key":"e_1_2_7_6_1","unstructured":"WHO.Latent Tuberculosis Infection2017. Available from:http:\/\/www.who.int\/tb\/challenges\/ltbi\/en\/"},{"key":"e_1_2_7_7_1","first-page":"82","article-title":"A cohort study of factors associated with LTBI treatment initiation and completion in Hamilton, Ontario, Canada","volume":"33","author":"Milinkovic D","year":"2018","journal-title":"Can J Infect Control"},{"key":"e_1_2_7_8_1","unstructured":"Public Health Agency of Canada.Tuberculosis Prevention and Control In Canada: A Federal Framework For Action.2014.https:\/\/www.canada.ca\/content\/dam\/phac\u2010aspc\/migration\/phac\u2010aspc\/tbpc\u2010latb\/pubs\/tpc\u2010pct\/assets\/pdf\/tpc\u2010pcta\u2010eng.pdf"},{"key":"e_1_2_7_9_1","volume-title":"Towards Tuberculosis Elimination: an Action Framework for Low\u2010Incidence Countries","author":"WHO","year":"2014"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jctube.2017.02.002"},{"key":"e_1_2_7_11_1","first-page":"1756","article-title":"Collaborative tuberculosis strategy for England: 2015 to 2020","author":"Public Health England, NHS England","year":"2015","journal-title":"Brit Med J Pub Grp"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.16.0299"},{"issue":"7","key":"e_1_2_7_13_1","first-page":"200","article-title":"Barriers to accepting and completing latent tuberculosis infection treatment","volume":"106","author":"Kane M","year":"2013","journal-title":"Ir Med J"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/hpm.2495"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-016-1550-y"},{"issue":"10","key":"e_1_2_7_16_1","first-page":"1134","article-title":"Treatment adherence of the latently infected tuberculosis population (post\u2010Katrina) at Wetmore TB Clinic, New Orleans, USA","volume":"12","author":"Bieberly J","year":"2008","journal-title":"Int J Tubercul Lung Dis"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.2011.tb03108.x"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200510-1667OC"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/07370010701429637"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.12.0692"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.17269\/cjph.104.3643"},{"issue":"2","key":"e_1_2_7_22_1","first-page":"34","article-title":"Adherence to latent tuberculosis infection treatment in a population with a high number of refugee children","volume":"100","author":"Rogo T","year":"2017","journal-title":"Rhode Island Mmedical Jjournal (2013)"},{"key":"e_1_2_7_23_1","unstructured":"Australian Government Department of Health.LTBI management in Australia 2016; Available from:http:\/\/www.who.int\/tb\/areas\u2010of\u2010work\/preventive\u2010care\/australia.pdf."},{"key":"e_1_2_7_24_1","volume-title":"TB Elimination: Interferon\u2010Gamma Release Assays (IGRAs)\u2010Blood Tests for TB Infection","author":"Centers for Disease Control","year":"2015"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0138349"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-11-247"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-015-1045-3"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.09-0394"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.14.0286"},{"key":"e_1_2_7_30_1","unstructured":"Government of Ontario.Laboratory test utilization management changes to the schedule of benefits\u2014laboratory services: diagnostic services and planning branch;2013"}],"container-title":["The International Journal of Health Planning and Management"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fhpm.2670","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hpm.2670","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hpm.2670","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hpm.2670","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,6]],"date-time":"2023-09-06T13:00:40Z","timestamp":1694005240000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hpm.2670"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,11,7]]},"references-count":29,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,1]]}},"alternative-id":["10.1002\/hpm.2670"],"URL":"https:\/\/doi.org\/10.1002\/hpm.2670","archive":["Portico"],"relation":{},"ISSN":["0749-6753","1099-1751"],"issn-type":[{"value":"0749-6753","type":"print"},{"value":"1099-1751","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,11,7]]},"assertion":[{"value":"2018-08-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-08-28","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-11-07","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}