“Home is where the patient is”: a qualitative analysis of a patient-centred model of care for multi-drug resistant tuberculosis

BMC Health Services Research

Philipp du Cros¹  Meggy Verputten³  Esther C Casas³  Samuel Kasozi²  Muhammad Shoaib³  Lucy Reynolds⁴  Beverley Stringer¹  Shona Horter⁴ 

[1]Médecins Sans Frontières (MSF), London, UK

[2]The National TB and Leprosy Programme, Ministry of Health, Kampala, Uganda

[3]MSF, Amsterdam, Netherlands

[4]The London School of Hygiene and Tropical Medicine, London, UK

关键词: Nosocomial;    Transmission;    Qualitative;    Acceptability;    Uganda;    Ambulatory;    Community;    Home-based care;    Multi-drug resistant tuberculosis (MDR-TB);   

Others  :  1134068
DOI  :  10.1186/1472-6963-14-81

 received in 2012-12-19, accepted in 2014-02-13,  发布年份 2014

【 摘 要 】

Background

Ambulatory, community-based care for multi-drug resistant tuberculosis (MDR-TB) has been found to be effective in multiple settings with high cure rates. However, little is known about patient preferences around models of MDR-TB care. Médecins Sans Frontières (MSF) has delivered home-based MDR-TB treatment in the rural Kitgum and Lamwo districts of northern Uganda since 2009 in collaboration with the Ministry of Health and the National TB and Leprosy Programme. We conducted a qualitative study examining the experience of patients and key stakeholders of home-based MDR-TB treatment.

Methods

We used semi-structured interviews and focus-group discussions to examine patients’ perceptions, views and experiences of home-based treatment and care for MDR-TB versus their perceptions of care in hospital. We identified how these perceptions interacted with those of their families and other stakeholders involved with TB. Participants were selected purposively following a stakeholder analysis. Sample size was determined by data saturation being reached within each identified homogenous category of respondents: health-care receiving, health-care providing and key informant. Iterative data collection and analysis enabled adaptation of topic guides and testing of emerging themes. The grounded theory method of analysis was applied, with data, codes and categories being continually compared and refined.

Results

Several key themes emerged: the perceived preference and acceptability of home-based treatment and care as a model of MDR-TB treatment by patients, family, community members and health-care workers; the fear of transmission of other infections within hospital settings; and the identification of MDR-TB developing through poor adherence to and inadequate treatment regimens for DS-TB.

Conclusions

Home-based treatment and care was acceptable to patients, families, communities and health-care workers and was seen as preferable to hospital-based care by most respondents. Home-based care was perceived as safe, conducive to recovery, facilitating psychosocial support and allowing more free time and earning potential for patients and caretakers. These findings could contribute to development of an adaptation of treatment approach strategy at national level.

【 授权许可】

   
2014 Horter et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]WHO: Global Tuberculosis Report 2012. Geneva: WHO; 2012.
• [2]WHO: Multidrug and Extensively Drug-Resistant TB (M/XDR-TB): 2010 Global Report on Surveillance and Response. Geneva: WHO; 2010.
• [3]Fitzpatrick C, Floyd K: A systematic review of the cost and cost effectiveness of treatment for multidrug-resistant tuberculosis. Pharmacoeconomics 2012, 30:63-80.
• [4]Smart T: Decentralised, patient-centred models of delivering treatment and palliative care for people with M/XDR-TB. HATIP 2010, 166:2-9. Available: https://www.aidsmap.com/pdf/HATIP-166-October-8th-2010/page/1520450/ webcite Accessed Jan 28, 2011
• [5]WHO: Global Tuberculosis Control 2011. Geneva: WHO; 2011.
• [6]Mitnick C, Bayons J, Palacios E, Shin S, Furin J, Alcantara F, Sanchez E, Sarria M, Becerra M, Smith Fawzi M, Kapiga S, Neuberg D, Maguire J, Yong Kim J, Farmer P: Community-based therapy for multidrug-resistant tuberculosis in Lima, Peru. NEJM 2003, 348:119-128.
• [7]Luyirika E, Nsobya H, Batamwita R, Busingye P, Musoke W, Nabiddo L, Karamagi Y, Mukasa B: A home-based approach to managing multi-drug resistant tuberculosis in Uganda: a case report. AIDS Res Ther 2012, 9:12. BioMed Central Full Text
• [8]Heller T, Lessells R, Wallrauch C, Barnighausen T, Cooke G, Mhlongo L, Master I, Newell M: Community-based treatment for multidrug-resistant tuberculosis in rural KwaZulu-Natal, South Africa. Int J Tuberc Lung Dis 2010, 14:420-426.
• [9]Chalco K, Wu D, Mestanza L, Munoz M, Llaro K, Guerra D, Palacios E, Furin J, Shin S, Sapag R: Nurses as providers of emotional support to patients with MDR-TB. Int Nurs Rev 2006, 53:253-260.
• [10]Nathanson E, Lambregts-van Weezenbeek C, Rich M, Gupta R, Bayona J, Blondal K, Caminero J, Cegielski P, Danilovits M, Espinal M, Hollo V, Jaramillo E, Leimane V, Mitnick C, Mukherjee J, Nunn P, Pasechnikov A, Tupasi T, Wells C, Raviglione M: Multidrug-resistant tuberculosis management in resource-limited settings. Emerg Infect Dis 2006, 12:1389-1397.
• [11]WHO: Treatment of Tuberculosis Guidelines. 4th edition. Geneva: WHO; 2010.
• [12]WHO: Guidelines for the Programmatic Management of Drug-Resistant Tuberculosis: 2011 Update. Geneva: WHO; 2011.
• [13]Furin J, Bayona J, Becerra M, Farmer P, Golubkov A, Hurtado R, Joseph JK, Keshavjee S, Ponomarenko O, Rich M, Shin S: Programmatic management of multidrug-resistant tuberculosis: models from three countries. Int J Tuberc Lung Dise-publication ahead of print 8 June 2011. doi:10.5588/ijtld.10.0591
• [14]Palacios E, Guerra D, Llaro K, Chalco K, Sapag R, Furin J: The role of the nurse in the community-based treatment of multidrug-resistant tuberculosis (MDR-TB). Int J Tuberc Lung Dis 2003, 7:343-346.
• [15]World Bank: Uganda at a glance – World Bank. Available: devdata.worldbank.org/AAG/uga_aag.pdf Accessed October 26, 2012
• [16]Kiwanuka SN, Ekirapa EK, Peterson S, Okui O, Hafizur Rahman M, Peters D, Pariyo GW: Access to and utilisation of health services for the poor in Uganda: a systematic review of available evidence. Trans R Soc Trop Med Hyg 2008, 102(11):1067-1074.
• [17]Shoaib M, Velivela K, Sharmin S, Seshadri P, Kasozi S, Casas EC, Verputten M: A decentralised, community-based model of care for DR-TB in northern Uganda. Poster presented at MSF Scientific Day 2012. Available: http://issuu.com/msfuk/docs/verputten_uganda_drtb/1 webcite Accessed Oct 23, 2012
• [18]WHO: The Stop TB Strategy: Building on and Enhancing DOTS to Meet the TB-Related Millennium Development Goals. Geneva: WHO; 2006.
• [19]Green J, Thorogood N: Qualitative Methods for Health Research. London: Sage Publications; 2009.
• [20]Basit T: Manual or electronic? The role of coding in qualitative data analysis. Educ Res 2003, 45:143-154.
• [21]Bradley E, Curry L, Devers K: Qualitative data analysis for health services research: developing taxonomy, themes and theory. Health Serv Res 2007, 42:1758-1772.
• [22]Jones-López EC, Ayakaka I, Levin J, Reilly N, Mumbowa F, Dryden-Peterson S, Nyakoojo G, Fennelly K, Temple B, Nakubulwa S, Joloba ML, Okwera A, Eisenach KD, McNerney R, Elliott AM, Ellner JJ, Smith PG, Mugerwa RD: Effectiveness of the standard WHO recommended retreatment regimen (Category II) for tuberculosis in Kampala, Uganda: a prospective cohort study. PLoS Med 2011, 8:e1000427.
• [23]Gelmanova IY, Taran DV, Mishustin SP, Golubkov AA, Solovyova AV, Keshavjee S: ‘Sputnik’: a programmatic approach to improve tuberculosis treatment adherence and outcome among defaulters. Int J Tuberc Lung Dis 2011, 15:1373-1379.
• [24]Noyes J, Popay J: Directly observed therapy and tuberculosis: how can a systematic review of qualitative research contribute to improving services? A qualitative meta-synthesis. J Adv Nurs 2007, 57:227-243.
• [25]Koch E: Tuberculosis is a threshold: the making of a social disease in post-Soviet Georgia. Med Anthropol 2013, 32:309-324.
• [26]Cavalcante SC, Durovni B, Barnes GL, Souza FB, Silva RF, Barroso PF, Mohan CI, Miller A, Golub JE, Chaisson RE: Community-randomized trial of enhanced DOTS for tuberculosis control in Rio de Janeiro, Brazil. Int J Tuberc Lung Dis 2010, 14:203-209.
• [27]Temple B, Ayakaka I, Ogwang S, Nabanjja H, Kayes S, Nakubulwa S, Worodria W, Levin J, Joloba M, Okwera A, Eisenach KD, McNerney R, Elliott AM, Smith PG, Mugerwa RD, Ellner JJ, Jones-López EC: Rate and amplification of drug resistance among previously-treated patients with tuberculosis in Kampala, Uganda. Clin Infect Dis 2008, 47:1126-1134.
• [28]Pasquet A, Messou E, Gabillard D, Minga A, Depoulosky A, Deuffic-Burban D, Losina E, Freedberg KA, Danel C, Anglaret X, Yazdanpanah Y: Impact of drug stock-outs on death and retention to care among HIV-infected patients on combination antiretroviral therapy in Abidjan, Cote d’Ivoire. PLoS One 2010, 5:e13414.
• [29]Malterud K: Qualitative research: standards, challenges and guidelines. Lancet 2001, 358:483-488.