“Take the treatment and be brave”: Care experiences of pregnant women with rifampicin-resistant tuberculosis

Abstract

Background There are few data on the on the care experiences of pregnant women with rifampicin-resistant TB. Objective To describe the treatment journeys of pregnant women with RR-TB—including how their care experiences shape their identities—and identify areas in which tailored interventions are needed. Methods In this qualitative study in-depth interviews were conducted among a convenience sample from a population of pregnant women receiving treatment for RR-TB. This paper follows COREQ guidelines. A thematic network analysis using an inductive approach was performed to analyze the interview transcripts and notes. The analysis was iterative and a coding system developed which focused on the care experiences of the women and how these experiences affected their perceptions of themselves, their children, and the health care system in which treatment was received. Results Seventeen women were interviewed. The women described multiple challenges in their treatment journeys which required them to demonstrate sustained resilience (i.e. to “be brave”). Care experiences required them to negotiate seemingly contradictory identities as both new mothers—“givers of life”—and RR-TB patients facing a complicated and potentially deadly disease. In terms of their “pregnancy identity” and “RR-TB patient identity” that emerged as part of their care experiences, four key themes were identified that appeared to have elements that were contradictory to one another (contradictory areas). These included: 1) the experience of physical symptoms or changes; 2) the experience of the “mothering” and “patient” roles; 3) the experience of the care they received for their pregnancy and their RR-TB; and 4) the experience of community engagement. There were also three areas that overlapped with both roles and during which identity was negotiated/reinforced and they included: 1) faith; 2) socioeconomic issues; and 3) long-term concerns over the child’s health. At times, the health care system exacerbated these challenges as the women were not given the support they needed by health care providers who were ill-informed or angry and treated the women in a discriminatory fashion. Left to negotiate this confusing time period, the women turned to faith, their own mothers, and the fathers of their unborn children. Conclusion The care experiences of the women who participated in this study highlight several gaps in the current health care system that must be better addressed in both TB and perinatal services in order to improve the therapeutic journeys for pregnant women with RR-TB and their children. Suggestions for optimizing care include the provision of integrated services, including specialized counseling as well as training for health care providers; engagement of peer support networks; provision of socioeconomic support; long-term medical care/follow-up for children born to women who were treated for RR-TB; and inclusion of faith-based services in the provision of care.

Best practices for the care of pregnant people living with TB

“…Many pregnant people report feeling isolated and stigmatized when they find out they have TB, something that is often inadvertently perpetuated by healthcare providers. 8 Even sympathetic providers may exacerbate feelings of anxiety and depression if they convey that ‘little is known’ about the risks of TB treatment during pregnancy. Although it is important to be honest when communicating the lack of high-quality data from large populations of pregnant people undergoing TB treatment, providers can be reassuring and supportive.…”

“… 7 The result is that while pregnant people are more likely to become sick from TB, they are less likely to receive high-quality person-centered care, placing them, their children and their families at risk of poor outcomes. 8 …”

Outcomes of Children Born to Pregnant Women With Drug-resistant Tuberculosis Treated With Novel Drugs in Khayelitsha, South Africa: A Report of Five Patients

“…2 Studies have shown that pregnant women with DR-TB may be offered substandard care, face a high degree of discrimination both from health care workers and from others in their communities, and are systematically denied access to treatment innovations that have been associated with decreased morbidity and mortality in other populations. 3 Not only do these issues affect the health of the pregnant women but also the lives of their unborn children. Children born to pregnant women with TB are at increased risk of prematurity, hospitalization, and death.…”

“…2 Studies have shown that pregnant women with DR-TB may be offered substandard care, face a high degree of discrimination both from health care workers and from others in their communities, and are systematically denied access to treatment innovations that have been associated with decreased morbidity and mortality in other populations. 3…”