“When Treatment Is More Challenging than the Disease”: A Qualitative Study of MDR-TB Patient Retention

Citation: Shringarpure KS, Isaakidis P, Sagili KD, Baxi RK, Das M, Daftary A (2016) “When Treatment Is More Challenging than the Disease”: A Qualitative Study of MDR-TB Patient Retention. PLoS ONE 11(3): e0150849. doi:10.1371/journal.pone.0150849
Published: March 9, 2016

India_GJ.svgBackground: One-fifth of the patients on multidrug-resistant tuberculosis treatment at the Drug-Resistant-TB (DR-TB) Site in Gujarat are lost-to-follow-up(LFU).
Objective: To understand patients’ and providers' perspectives on reasons for LFU and their suggestions to improve retention-in-care.
Design: Qualitative study conducted between December 2013-March 2014, including in-depth interviews with LFU patients and DOT-providers, and a focus group discussion with DR-TB site supervisors. A thematic-network analysis approach was utilised.
Results: Three sub-themes emerged: (i) Struggle with prolonged treatment; (ii) Strive against stigma and toward support; (iii) Divergent perceptions and practices. Daily injections, pill burden, DOT, migratory work, social problems, prior TB treatment, and adverse drugs effects were reported as major barriers to treatment adherence and retention-in-care by patients and providers. Some providers felt that despite their best efforts, LFU patients remain. Patient movements between private practitioners and traditional healers further influenced LFU.
Conclusion: The study points to a need for repeated patient counselling and education, improved co-ordination between various tiers of providers engaged in DR-TB care, collaboration between the public, private and traditional practitioners, and promotion of social and economic support to help patients adhere to MDR-TB treatment and avoid LFU.


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