“If We Have to Die, We Just Die”: Challenges and Opportunities for Tuberculosis and HIV/AIDS Prevention and Care in Northern Thailand

Ngamvithayapong-Yanai, Jintana; Winkvist, Anna; Luangjina, Sarmwai; Diwan, Vinod

doi:10.1177/1049732305281616

Cited by 9 publications

(6 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Studies on the social processes of diagnosis [ 17 , 18 ] mainly focus on treatment seeking behavior of patients. They show how stigma and disease perceptions influence healthcare seeking and diagnosis [ 19 – 21 ], reasons for delay in healthcare seeking [ 20 , 22 – 25 ], and what it means to live with a particular diagnosis [ 26 – 28 ]. Such studies generate important results and more studies into pathways to diagnosis are needed.…”

Section: Introductionmentioning

confidence: 99%

Barriers to Point-of-Care Testing in India: Results from Qualitative Research across Different Settings, Users and Major Diseases

et al. 2015

View full text Add to dashboard Cite

BackgroundSuccessful point-of-care testing, namely ensuring the completion of the test and treat cycle in the same encounter, has immense potential to reduce diagnostic and treatment delays, and impact patient outcomes. However, having rapid tests is not enough, as many barriers may prevent their successful implementation in point-of-care testing programs. Qualitative research on diagnostic practices may help identify such barriers across different points of care in health systems.MethodsIn this exploratory qualitative study, we conducted 78 semi-structured interviews and 13 focus group discussions in an urban and rural area of Karnataka, India, with healthcare providers (doctors, nurses, specialists, traditional healers, and informal providers), patients, community health workers, test manufacturers, laboratory technicians, program managers and policy-makers. Participants were purposively sampled to represent settings of hospitals, peripheral labs, clinics, communities and homes, in both the public and private sectors.ResultsIn the Indian context, the onus is on the patient to ensure successful point-of-care testing across homes, clinics, labs and hospitals, amidst uncoordinated providers with divergent and often competing practices, in settings lacking material, money and human resources. We identified three overarching themes affecting point-of-care testing: the main theme is ‘relationships’ among providers and between providers and patients, influenced by the cross-cutting theme of ‘infrastructure’. Challenges with both result in ‘modified practices’ often favouring empirical (symptomatic) treatment over treatment guided by testing.ConclusionsEven if tests can be conducted on the spot and infrastructure challenges have been resolved, relationships among providers and between patients and providers are crucial for successful point-of-care testing. Furthermore, these barriers do not act in isolation, but are interlinked and need to be examined as such. Also, a test alone has only limited power to overcome those difficulties. Test developers, policy-makers, healthcare providers and funders need to use these insights in overcoming barriers to point-of-care testing programs.

show abstract

Section: Introductionmentioning

confidence: 99%

Barriers to Point-of-Care Testing in India: Results from Qualitative Research across Different Settings, Users and Major Diseases

et al. 2015

View full text Add to dashboard Cite

show abstract

“…However, little attention has been paid to patient‐level factors and behaviour impacting transmission, and there are no data in the context of highly drug‐resistant TB. Furthermore, qualitative studies on TB have assessed health‐seeking behaviour , the influence of stigma and perception on seeking health care , reasons for delayed diagnosis and the meaning of living with a TB diagnosis . However, little or no studies have investigated the lifestyle, attitudes, or adherence of patients with XDR‐TB and the experience associated with failing treatment.…”

Section: Introductionmentioning

confidence: 99%

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

Senthilingam

Pietersen

McNerney

et al. 2015

Tropical Med Int Health

View full text Add to dashboard Cite

Summaryobjective 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 underrecognised 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.

show abstract

“…Yet, qualitative research on TB diagnostics is scarce. The few published studies have mainly focused on how stigma and disease perceptions influence healthcare seeking and diagnosis [ 4 , 5 ], reasons for delay in healthcare seeking [ 5 – 7 ] and what it means to live with TB diagnosis [ 8 ]. Such studies generate important insights for test developers, and more research is needed into patient needs and pathways to diagnosis.…”

mentioning

confidence: 99%

Tuberculosis diagnostics: Why we need more qualitative research

Engel¹,

Pai²

2013

JEGH

View full text Add to dashboard Cite

“If We Have to Die, We Just Die”: Challenges and Opportunities for Tuberculosis and HIV/AIDS Prevention and Care in Northern Thailand

Cited by 9 publications

References 22 publications

Barriers to Point-of-Care Testing in India: Results from Qualitative Research across Different Settings, Users and Major Diseases

Barriers to Point-of-Care Testing in India: Results from Qualitative Research across Different Settings, Users and Major Diseases

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

Tuberculosis diagnostics: Why we need more qualitative research

Contact Info

Product

Resources

About