{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T18:01:05Z","timestamp":1790704865728,"version":"4.1.0"},"reference-count":59,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Fogarty International Center of the National Institutes of Health","award":["R21TW011740"],"award-info":[{"award-number":["R21TW011740"]}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>People with multiple long-term conditions (MLTC) in low-resource settings face high treatment burdens, influenced by healthcare access and quality disparities. The study aimed to compare the treatment burden among patients with MLTC across geographical locations and healthcare providers in Peru. We conducted a cross-sectional study conducted between June\u2013October 2023 among outpatients aged \u226540 years with type 2 diabetes and \u22651 additional chronic condition, recruited from public and private healthcare facilities in urban Lima and semi-urban Tumbes, Peru. Treatment burden was assessed using the Multimorbidity Treatment Burden Questionnaire (MTBQ). Differences in median MTBQ scores by setting and healthcare provider were analyzed using regression models adjusting for capacity- and workload-related variables. Among 555 participants (55% female, mean age 62.4\u2009\u00b1\u200910.5 years), median MTBQ score was 27.1 (IQR 14.6-41.7). After adjustment, patients in semi-urban Tumbes had higher treatment burden than those in urban Lima (adjusted median difference 6.1 points; 95% CI 2.9 to 9.3), while patients receiving care in private facilities had lower treatment burden than those in public settings (\u22126.6 points; 95% CI \u22129.3 to \u22123.9). These findings highlight substantial inequalities in treatment burden by place and provider type, with implications for efforts to improve care delivery and reduce disparities for people living with MLTC.<\/jats:p>","DOI":"10.1371\/journal.pgph.0007355","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T17:27:43Z","timestamp":1790702863000},"page":"e0007355","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Disparities in treatment burden in Peru among people with multiple long-term conditions by geography and\u00a0healthcare facility: A cross-sectional study"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4860-587X","authenticated-orcid":true,"given":"Silvana","family":"Perez-Leon","sequence":"first","affiliation":[{"name":"Universidad Peruana Cayetano Heredia","place":["Lima, Peru"],"department":["CRONICAS Center of Excellence in Chronic Diseases"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0174-5816","authenticated-orcid":true,"given":"Daniel","family":"Mendoza-Quispe","sequence":"additional","affiliation":[{"name":"Universidad Peruana Cayetano Heredia","place":["Lima, Peru"],"department":["CRONICAS Center of Excellence in Chronic Diseases"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Sofia","family":"Cuba-Fuentes","sequence":"additional","affiliation":[{"name":"Universidad Peruana Cayetano Heredia","place":["Lima, Peru"],"department":["Department of Medicine, Faculty of Medicine"]},{"name":"Universidad Peruana Cayetano Heredia","place":["Lima, Peru"],"department":["Center for research in Primary Health Care"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6169-8049","authenticated-orcid":true,"given":"Juan Carlos","family":"Bazo-Alvarez","sequence":"additional","affiliation":[{"name":"Universidad Peruana Cayetano Heredia","place":["Lima, Peru"],"department":["CRONICAS Center of Excellence in Chronic Diseases"]},{"name":"University College London","place":["London, United Kingdom"],"department":["Research Department of Primary Care and Population Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Amalia Pesantes","sequence":"additional","affiliation":[{"name":"Universidad Peruana Cayetano Heredia","place":["Lima, Peru"],"department":["CRONICAS Center of Excellence in Chronic Diseases"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4139-1840","authenticated-orcid":true,"given":"Andrea","family":"Gaspar","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Center","place":["Pittsburgh, Pennsylvania, United States of America"],"department":["Department of General Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph R.","family":"Zunt","sequence":"additional","affiliation":[{"name":"University of Washington","place":["Seattle, Washington, United States of America"],"department":["Departments of Neurology, Global Health, Medicine (Infectious Diseases), and Epidemiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0595-2898","authenticated-orcid":true,"given":"Victor M.","family":"Montori","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, Minnesota, United States of America"],"department":["Knowledge and Evaluation Research Unit"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3349-6503","authenticated-orcid":true,"given":"Jose Armando","family":"Castillo","sequence":"additional","affiliation":[{"name":"Universidad Peruana Cayetano Heredia","place":["Lima, Peru"],"department":["CRONICAS Center of Excellence in Chronic Diseases"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1371-6393","authenticated-orcid":true,"given":"Eduardo","family":"Carcausto","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universidad de San Mart\u00edn de Porres","place":["Lima, Peru"]},{"name":"Cl\u00ednica Internacional","place":["Lima, Peru"],"department":["Department of Internal Medicina"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7833-2852","authenticated-orcid":true,"given":"Nelson","family":"Diaz","sequence":"additional","affiliation":[{"name":"Universidad Peruana Union","place":["Lima, Peru"],"department":["School of Medicine"]},{"name":"Department of Medicine, Cl\u00ednica Good Hope","place":["Lima, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keveen","family":"Salirrosas","sequence":"additional","affiliation":[{"name":"Corporate Medical Directorate, Cl\u00ednica M\u00e9dica Cayetano Heredia","place":["Lima, Per\u00fa"]},{"name":"Universidad Peruana Cayetano Heredia","place":["Lima, Peru"],"department":["Department of Postgraduate Studies, School of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pilar","family":"Cornejo","sequence":"additional","affiliation":[{"name":"Universidad Peruana Cayetano Heredia","place":["Lima, Peru"],"department":["Department of Medicine, Faculty of Medicine"]},{"name":"Hospital Arzobispo Loayza","place":["Lima, Per\u00fa"],"department":["Department of Endocrinology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4738-5468","authenticated-orcid":true,"given":"J. Jaime","family":"Miranda","sequence":"additional","affiliation":[{"name":"Universidad Peruana Cayetano Heredia","place":["Lima, Peru"],"department":["CRONICAS Center of Excellence in Chronic Diseases"]},{"name":"Universidad Peruana Cayetano Heredia","place":["Lima, Peru"],"department":["Department of Medicine, Faculty of Medicine"]},{"name":"The University of Sydney","place":["Sydney, New South Wales, Australia"],"department":["Sydney School of Public Health, Faculty of Medicine and Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"pgph.0007355.ref001","unstructured":"Academy of Medical Sciences. Multimorbidity: A priority for global health research. London: Academy of Medical Sciences; 2018. 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