<?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>0864-3466</journal-id>
<journal-title><![CDATA[Revista Cubana de Salud Pública]]></journal-title>
<abbrev-journal-title><![CDATA[Rev Cubana Salud Pública]]></abbrev-journal-title>
<issn>0864-3466</issn>
<publisher>
<publisher-name><![CDATA[Editorial Ciencias Médicas]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0864-34662020000400006</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Determinantes del acceso a los servicios de salud y adherencia al tratamiento de la tuberculosis]]></article-title>
<article-title xml:lang="en"><![CDATA[Determinants of the access to health services and adherence to TB treatment]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rivera-Lozada]]></surname>
<given-names><![CDATA[Oriana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rivera-Lozada]]></surname>
<given-names><![CDATA[Isabel Cristina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Bonilla-Asalde]]></surname>
<given-names><![CDATA[César Antonio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad Norbert Wiener  ]]></institution>
<addr-line><![CDATA[Lima ]]></addr-line>
<country>Perú</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad del Cauca  ]]></institution>
<addr-line><![CDATA[Popayán ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Universidad Privada San Juan Bautista  ]]></institution>
<addr-line><![CDATA[Lima ]]></addr-line>
<country>Peru</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2020</year>
</pub-date>
<volume>46</volume>
<numero>4</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_arttext&amp;pid=S0864-34662020000400006&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_abstract&amp;pid=S0864-34662020000400006&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_pdf&amp;pid=S0864-34662020000400006&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN  Introducción: El papel fundamental de un sistema de salud es responder a las necesidades de la población, lo cual implica desarrollar mecanismos que permitan una prestación integral, accesible y equitativa a sus servicios.  Objetivos: Valorar las barreras de acceso a la atención de salud y la adherencia en pacientes con tuberculosis en una región de alta carga en el Perú.  Métodos: Investigación de enfoque mixto, realizada en el periodo de enero a septiembre del 2018 en 120 pacientes con tuberculosis. Para el enfoque cuantitativo se realizó un estudio transversal analítico, donde se abordaron preguntas de acceso a servicios de salud utilizando el modelo de Tanahashi. La adherencia al tratamiento fue medida a través del test de Morisky-Green. Para el diseño cualitativo se utilizó la metodología de grupos focales con 30 pacientes para profundizar sus experiencias acerca de los determinantes de acceso.  Resultados: La mayoría de las barreras se identificaron en las dimensiones: aceptabilidad, contacto y disponibilidad. Se encontró asociación entre la adherencia al tratamiento y los siguientes indicadores: el temor o vergüenza de atenderse en un servicio de salud, desconfianza con los equipos de salud, percepción de mala calidad de la atención, falta de conciencia de la enfermedad, efectos secundarios de los medicamentos el número y tamaño de las píldoras.  Conclusiones: Los hallazgos del presente estudio sugieren la existencia de barreras contextuales y del sistema de salud que impiden el acceso a los pacientes con tuberculosis, y si estas no se tienen en consideración podrían dificultar la adherencia del tratamiento para tuberculosis. Sin embargo, conseguir actuar dentro de una lógica que privilegie una asistencia centrada en el paciente, considerando sus singularidades y autonomía frente al proceso terapéutico puede tornarse una tarea difícil para los servicios de salud donde la demanda supera los recursos y su estructura.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Introduction:  The fundamental role of a health system is to respond to the needs of the population, which involves developing mechanisms that enable a comprehensive, accessible and equitable delivery of its services.  Objectives:  Assess access barriers to health care and adherence in TB patients in a high-burden region of Peru.  Methods:  Mixed-approach research conducted in the period January to September 2018 in 120 TB patients. For the quantitative approach, an analytical cross-sectional study was conducted, where questions on access to health services were addressed using the Tanahashi model. Adherence to treatment was measured through the Morisky-Green test. For qualitative design, the focus group methodology with 30 patients was used to deepen in their experiences of access determinants.  Results:  Most barriers were identified in the following dimensions: acceptability, contact and availability. An association was found between adherence to treatment and the following indicators: the fear or shame of being attended in a health service, mistrust with health teams, perception of poor quality of care, lack of awareness of the disease, side effects of medications, the number and size of the pills.  Conclusions:  The findings of this study suggest contextual and health system barriers that prevent access to TB patients, and if these are not taken into account, they could hinder adherence to TB treatment. However, acting within a logic that favors patient-centered care, considering its uniqueness and autonomy from the therapeutic process can become a difficult task for health services where demand exceeds the resources and their structure.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[acceso a los servicios de salud]]></kwd>
<kwd lng="es"><![CDATA[tuberculosis]]></kwd>
<kwd lng="es"><![CDATA[adherencia al tratamiento]]></kwd>
<kwd lng="en"><![CDATA[Access to health services]]></kwd>
<kwd lng="en"><![CDATA[tuberculosis]]></kwd>
<kwd lng="en"><![CDATA[adherence to treatment]]></kwd>
</kwd-group>
</article-meta>
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