Hospitalized care for MDR-TB in Port Harcourt, Nigeria: a qualitative study

Abstract

BackgroundIn Nigeria multidrug-resistant tuberculosis (MDR-TB) is prevalent in 2.9% of new TB cases and 14% of retreatment cases, and the country is one of 27 with high disease burden globally. Patients are admitted and confined to one of ten MDR-TB treatment facilities throughout the initial 8 months of treatment. The perspectives of MDR-TB patients shared on social media and in academic research and those of providers are limited to experiences of home-based care. In this study we explored the views of hospitalised MDR-TB patients and providers in one treatment facility in Nigeria, and describe how their experiences are linked to accessibility of care and support services, in line with international goals. We aimed to explore the physical, social and psychological needs of hospitalized MDR TB patients, examine providers’ perceptions about the hospital based model and discuss the model’s advantages and disadvantages from the patient and the provider perspective.MethodsWe conducted two gender distinct focus group discussions and 11 in-depth interviews with recently discharged MDR-TB patients from one MDR-TB treatment facility in Nigeria. We triangulated this with the views of four providers who played key roles in the management of MDR-TB patients via key informant interviews. Transcribed data was thematically analysed, using an iterative process to constantly compare and contrast emerging themes across the data set for deeper understanding of the full range of participants’ views.ResultsThe study findings demonstrate the psycho-social impacts of prolonged isolation and the coping mechanisms of patients in the facility. The dislocation of patients from their normal social networks and the detachment between providers and patients created the need for interdependence of patients for emotional and physical support. Providers’ fears of infection contributed to stigma and hindered accessibility of care and support services.ConclusionThe current trend towards discharging patients after culture conversion would reduce the psycho-social impacts of prolonged isolation and potentially reduce the risk of occupational TB from prolonged contact with MDR-TB patients. Building on shared experiences and interdependence of MDR-TB patients in our study, innovative patient-centred support systems would likely help to reduce stigma, promote access to care and support services, and potentially impact on the outcome of treatment.

Ease and equity of access to free DR-TB services in Nigeria- a qualitative analysis of policies, structures and processes

“…Poor approachability and ability to perceive often resulted in patients not being accepting of available services, preferring alternatives. This has been highlighted in other SSA studies (57,58,70,71).…”

Factors influencing diagnosis and treatment initiation for multidrug-resistant/rifampicin-resistant tuberculosis in six sub-Saharan African countries: a mixed-methods systematic review

“…► Professional values, norms and attitude 45 ► Care attributes-infection control, long duration of hospitalisation/ treatment 40 45 Ability to seek:…”

“…► Reduce hospitalisation duration 45 ► -Strengthen infection control measures and occupational health services. 29 31 40 45 ► Increase home-based care of DR-TB 42 45 ► Improve visitation policies for hospitalised patients 45 ► More attention to patient-level barriers. 29 33 Structural access dimensions and barriers (study ID #)…”

Morbimortalidade hospitalar por tuberculose pulmonar na Bahia e entre 2010 a 2014

“…Contudo, o número de hospitalizações poderia ser reduzido com estratégias da atenção primária evitando o atendimento de emergência e diminuindo o quantitativo de internações hospitalares por tuberculose. [18][19][20] Quanto aos custos econômicos com as hospitalizações, são presentes os desfalques no orçamento público voltados para o tratamento da TB em países em desenvolvimento como o Brasil, além do aumento de casos resistentes que estão envolvidos com a elevação dos custos. Além disso, os gastos com essa doença também oneram os orçamentos familiares, que pode estar relacionado diretamente ao tratamento e principalmente à perda de renda por conta da doença e internação.…”