Lifestyle, attitudes and needs of uncured XDR-TB patients living in the communities of South Africa: a qualitative study

Meera Senthilingam; Elize Pietersen; Ruth McNerney; Julian Te Riele; Pat Sedres; Ruth Wilson; Keertan Dheda

doi:10.1111/tmi.12532

Lifestyle, attitudes and needs of uncured XDR-TB patients living in the communities of South Africa: a qualitative study

Trop Med Int Health. 2015 Sep;20(9):1155-1161. doi: 10.1111/tmi.12532. Epub 2015 May 18.

Authors

Meera Senthilingam¹, Elize Pietersen², Ruth McNerney¹, Julian Te Riele³, Pat Sedres², Ruth Wilson², Keertan Dheda²

Affiliations

¹ Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
² Lung Infection and Immunity Unit, University of Cape Town, South Africa.
³ Brooklyn Chest Hospital, Cape Town, South Africa.

PMID: 25941041
DOI: 10.1111/tmi.12532

Abstract

Objective: Patient-level data are required to inform strategies interrupting transmission and default in patients with extensively drug-resistant TB (XDR-TB) to improve models of care and identify potential routes of transmission. We therefore explored the experiences, lifestyle, attitudes and needs of patients with uncured XDR-TB, who failed or interrupted therapy, living without treatment in the community.

Methods: We conducted in-depth interviews with 12 community-based patients from South Africa. Family members were interviewed when patients were unavailable. Interviews were analysed using inductive thematic analysis.

Results: The thematic experiences identified from the interviews were as follows: (i) living with but not being cured of XDR-TB, (ii) altered lifestyle in the community, (iii) experiences with community health care, (iv) local community members, and (v) wants and needs. Patients identified mistrust in health care, futility of treatment regimens, a need for a purpose in life and subsistence as major concerns. Restriction of living in the community for patients whose treatment had failed resulted in self-imposed isolation. Defaulters focused more on the never-ending drug regimen and bad experiences with health care contributing to non-adherence. Family members emphasised an under-recognised experience of unforeseen burden, obligation, worry and discomfort. Lack of knowledge and lack of concern about transmission was evident.

Conclusion: Current models of care are not adequately meeting the needs of patients with uncured XDR-TB and relatives. These data inform the need for community-based palliative care, vocational facilities to improve economic opportunities, home-based infection control and improved psychosocial support to increase patient adherence, reduce transmission, provide income and relieve the burden on family members.

Keywords: Afrique du Sud; South Africa; Sudáfrica; cualitativo; extensively drug-resistant tuberculosis; fallo en el tratamiento; qualitatif; qualitative; resistance; resistencia; résistance; treatment failure; tuberculose; tuberculose ultra résistante; tuberculosis; tuberculosis extremadamente drogorresistente; échec du traitement.