Community perspectives on tuberculosis care in rural South Africa

Abstract

Patient nonadherence to tuberculosis (TB) treatment is an ongoing challenge, particularly since the advent of drug-resistant TB and complications posed by HIV/AIDS. Some solutions may lie in understanding patient and community perspectives about barriers to TB care and treatment adherence. Using a qualitative framework, we explored community perceptions and beliefs about TB and perceived facilitators and barriers to care in a rural South African community affected by TB. We were particularly interested in capturing cross-cutting themes and the "merged voices" of participants. Interviews were conducted in 2013 and 2014 with 43 participants, including home-based care workers, clinic staff, patients living with TB and community members in and around a primary healthcare clinic. The data were analysed using principles of thematic analysis. The study reveals the complex interplay between contextual factors and community understandings of the disease. Cultural beliefs about causality and treatment-seeking paths were often mentioned in conjunction with biomedical views. There was a strong interface between TB and HIV in this community, and knowledge of TB was often confused with HIV. HIV-related stigma has been extended to those living with TB. The impact of poverty on treatment adherence was a particularly important theme. Other themes related to the role of the clinic in the community. Our study highlights the socioeconomic vulnerability of this community and the fragility of existing care systems. The findings reinforce the need for a community-centred approach to TB care that takes cognisance of lifeworld issues. We discuss some implications of this study for practice and policy.

Socio-economic challenges faced by traditional healers in Limpopo province of South Africa: conversations from below

“…Literature indicates that traditional healing is the most relevant route to addressing health issues for most of the population, because most people live in rural areas. The findings reported above are consistent with research conducted by Watermeyer and Penn (2019), who found that patients in rural settings of South Africa often access both traditional and scientific approaches to healing: their dual belief systems correspond with their treatment-seeking paths. Brandt and Rozin (2013) claim that “the way a society responds to disease reveals its deepest cultural, social and moral values” (p. 148).…”

An Australian study on the benefits of pastoral care to aged care residents in Christian affiliated homes

“…Qualitative data were imported into NVIVO, version 11, and analysed using principles of thematic analysis (Braun & Clarke, ). A rigorous research process was ensured through peer debrief and careful scrutiny and discussion of the transcripts (Watermeyer & Penn, ). The second author and an experienced qualitative researcher independently coded a subset of the data, discussed emerging themes and then categorised the data into five overarching themes.…”

Elucidating the Antimycobacterial Mechanism of Action of Decoquinate Derivative RMB041 Using Metabolomics

“…Infection with MDR-and XDR-TB requires more expensive treatment approaches, for a longer treatment duration, using drugs that have a higher risk of adverse side effects [6,7], which in turn leads to poorer patient compliance and subsequently an escalated increase of drug resistant TB [8]. Further contributing factors to the development of drug resistant TB include inaccurate diagnosis, unsupervised treatment protocols, and Antibiotics 2021, 10, 693 2 of 12 poor economic status [9][10][11] , , and in 2020, this was further exacerbated by the COVID-19 pandemic [1,12]. Over the last 50 years, the only new antimycobaterial compounds to be approved, as last-resort options, are the anti-TB drugs linezolid, bedaquiline, and delamanid [3][4][5]13].…”