Research Article Barriers and Delays in Tuberculosis Diagnosis and Treatment Services: Does Gender Matter? Wei-Teng Yang, 1 Celine R. Gounder, 2 Tokunbo Akande, 1 Jan-Walter De Neve, 3 Katherine N. McIntire, 2 Aditya Chandrasekhar, 1 Alan de Lima Pereira, 1 Naveen Gummadi, 4 Santanu Samanta, 5 and Amita Gupta 1,2,6 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA 2 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA 3 Harvard School of Public Health, Boston, MA 02115, USA 4 Narayana Hrudayalaya Hospital, Hyderabad 500055, India 5 All India Institute of Medical Sciences, New Delhi 110029, India 6 Center for Clinical Global Health Education, 600 North Wolfe Street, Phipps 540B, Baltimore, MD 21287, USA Correspondence should be addressed to Amita Gupta; agupta25@jhmi.edu Received 12 January 2014; Accepted 7 April 2014; Published 28 April 2014 Academic Editor: Edward A. Graviss Copyright © 2014 Wei-Teng Yang et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Tuberculosis (TB) remains a global public health problem with known gender-related disparities. We reviewed the quantitative evidence for gender-related diferences in accessing TB services from symptom onset to treatment initiation. Methods. Following a systematic review process, we: searched 12 electronic databases; included quantitative studies assessing gender diferences in accessing TB diagnostic and treatment services; abstracted data; and assessed study validity. We deined barriers and delays at the individual and provider/system levels using a conceptual framework of the TB care continuum and examined gender- related diferences. Results. Among 13,448 articles, 137 were included: many assessed individual-level barriers (52%) and delays (42%), 76% surveyed persons presenting for care with diagnosed or suspected TB, 24% surveyed community members, and two- thirds were from African and Asian regions. Many studies reported no gender diferences. Among studies reporting disparities, women faced greater barriers (inancial: 64% versus 36%; physical: 100% versus 0%; stigma: 85% versus 15%; health literacy: 67% versus 33%; and provider-/system-level: 100% versus 0%) and longer delays (presentation to diagnosis: 45% versus 0%) than men. Conclusions. Many studies found no quantitative gender-related diferences in barriers and delays limiting access to TB services. When diferences were identiied, women experienced greater barriers and longer delays than men. 1. Introduction Tuberculosis (TB) remains a signiicant global public health issue. Signiicantly, the TB disease burden is unequally dis- tributed among men and women. Of the estimated 8.7 million incident TB cases and 1.4 million deaths caused by TB globally in 2011, roughly one-third occurred among women (2.9 million incident TB cases and 0.5 million deaths) [1]. Currently, it is unclear whether these disparities are due to sex-related diferences (i.e., biology), gender-based diferences (i.e., sociocultural practices and diferent social roles of men and women), or both [2–4]. Until recently, gender-related diferences in the epidemiology, diagnosis, treatment, outcomes, and socioeconomic costs of TB have received relatively little attention. To address this knowledge gap, the World Health Organization (WHO) has proposed a framework and priorities for research on gender and TB [5]. To date, gender-based research supports that men and women respond diferently to illness and face diferent barriers when accessing TB diagnostic and treatment ser- vices [2]. Barriers that limit access to TB services occur at the individual and provider/system levels. Individual-level barriers involve physical (distance to TB services and access to transport), inancial (the direct and indirect costs of seeking TB services), stigma (stigma surrounding TB and its association with HIV), health literacy (TB-related knowledge Hindawi Publishing Corporation Tuberculosis Research and Treatment Volume 2014, Article ID 461935, 15 pages http://dx.doi.org/10.1155/2014/461935