"When Treatment Is More Challenging than the Disease": A Qualitative Study of MDR-TB Patient Retention

Kalpita S Shringarpure; Petros Isaakidis; Karuna D Sagili; R K Baxi; Mrinalini Das; Amrita Daftary

doi:10.1371/journal.pone.0150849

"When Treatment Is More Challenging than the Disease": A Qualitative Study of MDR-TB Patient Retention

PLoS One. 2016 Mar 9;11(3):e0150849. doi: 10.1371/journal.pone.0150849. eCollection 2016.

Authors

Kalpita S Shringarpure¹, Petros Isaakidis², Karuna D Sagili³, R K Baxi¹, Mrinalini Das⁴, Amrita Daftary^{5

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Affiliations

¹ Department of Preventive Social Medicine, Medical College, Baroda, India.
² Operational Research Unit, Médecins Sans Frontières, Mumbai, India.
³ The Union, South East Asia Office, New Delhi, India.
⁴ Operational Research Unit, Médecins Sans Frontières, Delhi, India.
⁵ McGill International TB Centre, McGill University, Montreal, Canada.
⁶ Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R. Mandela School of Medicine, University of Kwazulu Natal, Durban, South Africa.
⁷ Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.

Abstract

Background: One-fifth of the patients on multidrug-resistant tuberculosis treatment at the Drug-Resistant-TB (DR-TB) Site in Gujarat are lost-to-follow-up(LFU).

Objective: To understand patients' and providers' perspectives on reasons for LFU and their suggestions to improve retention-in-care.

Design: Qualitative study conducted between December 2013-March 2014, including in-depth interviews with LFU patients and DOT-providers, and a focus group discussion with DR-TB site supervisors. A thematic-network analysis approach was utilised.

Results: Three sub-themes emerged: (i) Struggle with prolonged treatment; (ii) Strive against stigma and toward support; (iii) Divergent perceptions and practices. Daily injections, pill burden, DOT, migratory work, social problems, prior TB treatment, and adverse drugs effects were reported as major barriers to treatment adherence and retention-in-care by patients and providers. Some providers felt that despite their best efforts, LFU patients remain. Patient movements between private practitioners and traditional healers further influenced LFU.

Conclusion: The study points to a need for repeated patient counselling and education, improved co-ordination between various tiers of providers engaged in DR-TB care, collaboration between the public, private and traditional practitioners, and promotion of social and economic support to help patients adhere to MDR-TB treatment and avoid LFU.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Adolescent
Adult
Female
Humans
Male
Middle Aged
Perception
Qualitative Research*
Social Stigma
Tuberculosis, Multidrug-Resistant / therapy*
Young Adult

Grants and funding

Funding for the operational research course was made possible by the support of the American People through the United States Agency for International Development (USAID). Funding for the project was made possible through support of the State RNTCP Cell, Gandhinagar. Funders had no role in study design, data collection, analysis and interpretation of data, decision to publish or preparation of the manuscript. The contents of this paper do not necessarily reflect the views of USAID, the United States Government, International Union Against Tuberculosis and Lung Disease (The Union) or the State RNTCP cell, Gujarat.