“My Favourite Day Is Sunday”: Community Perceptions of (Drug-Resistant) Tuberculosis and Ambulatory Tuberculosis Care in Kara Suu District, Osh Province, Kyrgyzstan

Abstract

ObjectivesKyrgyzstan is one of the 27 high multidrug-resistant tuberculosis (MDR-TB) burden countries listed by the WHO. In 2012, Médecins Sans Frontières (MSF) started a drug-resistant tuberculosis (DR-TB) project in Kara Suu District. A qualitative study was undertaken to understand the perception of TB and DR-TB in order to improve the effectiveness and acceptance of the MSF intervention and to support advocacy strategies for an ambulatory model of care.MethodsThis paper reports findings from 63 interviews with patients, caregivers, health care providers and members of communities. Data was analysed using a qualitative content analysis. Validation was ensured by triangulation and a ‘thick’ description of the research context, and by presenting deviant cases.ResultsFindings show that the general population interprets TB as the ‘lungs having a cold’ or as a ‘family disease’ rather than as an infectious illness. From their perspective, individuals facing poor living conditions are more likely to get TB than wealthier people. Vulnerable groups such as drug and alcohol users, homeless persons, ethnic minorities and young women face barriers in accessing health care. As also reported in other publications, TB is highly stigmatised and possible side effects of the long treatment course are seen as unbearable; therefore, people only turn to public health care quite late. Most patients prefer ambulatory treatment because of the much needed emotional support from their social environment, which positively impacts treatment concordance. Health care providers favour inpatient treatment only for a better monitoring of side effects. Health staff increasingly acknowledges the central role they play in supporting DR-TB patients, and the importance of assuming a more empathic attitude.ConclusionsHealth promotion activities should aim at improving knowledge on TB and DR-TB, reducing stigma, and fostering the inclusion of vulnerable populations. Health seeking delays and adherence problems will be countered by further implementation of shortened treatment regimens. An ambulatory model of care is proposed when convenient for the patient; hospitalisation is favoured only when seen as more appropriate for the respective individual.

Knowledge, Attitudes, and Prevention Practices of Drug Resistant Tuberculosis in the Eastern Cape Province, South Africa

“…These findings were similar to those of a previous study by [24]. Similar results were found in previous studies by [10, 45] where more than a third of the respondents believed that MDR-TB was transmitted and caused by kissing and touching infected people and therefore avoid kissing and touching the infected persons were regarded as means of preventing infection and its spread. The results show that in the present study, (39%) of the respondents knew that avoiding sharing of dishes, cups, and linen with the infected is not a preventative practice against the spread and transmission of Drug Resistant TB.…”

Barriers to access and adherence to tuberculosis services, as perceived by patients: A qualitative study in Mozambique

“…Stigma continues to be a barrier to accessing and adhering to treatment and is not unique to the sub-Saharan context–a study in Eastern Europe shows that TB is highly stigmatizing [19]. Having TB is often seen as equivalent to the stigma associated with being HIV infected, or even a higher perceived stigma as seen in a study in Southern Mozambique [20].…”

Representations on adherence to the treatment of Multidrug-Resistant Tuberculosis

“…However, DOT becomes even more important for MDR-TB treatment due to the frequent adverse reactions and the long treatment period, which are the main reasons for treatment being discontinued (25) . In addition, establishing a bond and trust, both of which are important for treatment adherence, are derived from daily contact, user embracement, and from qualified listening, which allows the professional to identify the needs of the person being treated for MDR-TB, in addition to sharing problems that afflict the patient, thereby enabling to strengthen the patient for the treatment (7,26) . This study evidenced the shortcomings encountered by individuals with MDR-TB and who, even in adverse situations, were transposed, which resulted in them being cured.…”