What clinic closure reveals about care for drug-resistant TB: a qualitative study
Abstract Background There have been calls for “person-centered” approaches to drug-resistant tuberculosis (DR-TB) care. In 2020, Charles James Hospital in South Africa, which incorporated person-centered care, was closed. Patients were referred mid-course to a centralized, tertiary hospital, providi...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-023-08405-7 |
| _version_ | 1797774372845387776 |
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| author | Thiloshini Govender Jennifer J. Furin Alex Edwards Selvan Pillay Richard A. Murphy |
| author_facet | Thiloshini Govender Jennifer J. Furin Alex Edwards Selvan Pillay Richard A. Murphy |
| author_sort | Thiloshini Govender |
| collection | DOAJ |
| description | Abstract Background There have been calls for “person-centered” approaches to drug-resistant tuberculosis (DR-TB) care. In 2020, Charles James Hospital in South Africa, which incorporated person-centered care, was closed. Patients were referred mid-course to a centralized, tertiary hospital, providing an opportunity to examine person-centered DR-TB and HIV care from the perspective of patients who lost access to it. Methods The impact of transfer was explored through qualitative interviews performed using standard methods. Analysis involved grounded theory; interviews were assessed for theme and content. Results After switching to the centralized site, patients reported being unsatisfied with losing access to a single clinic and pharmacy where DR-TB, HIV and chronic disease care were integrated. Patients also reported a loss of care continuity; at the decentralized site there was a single, familiar clinician whereas the centralized site had multiple, changing clinicians and less satisfactory communication. Additionally, patients reported more disease-related stigma and less respectful treatment, noting the loss of a “special place” for DR-TB treatment. Conclusion By focusing on a DR-TB clinic closure, we uncovered aspects of person-centered care that were critical to people living with DR-TB and HIV. These perspectives can inform how care for DR-TB is operationalized to optimize treatment retention and effectiveness. |
| first_indexed | 2024-03-12T22:20:05Z |
| format | Article |
| id | doaj.art-b6d1e70e5124475fb562fd01850249eb |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-03-12T22:20:05Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-b6d1e70e5124475fb562fd01850249eb2023-07-23T11:07:54ZengBMCBMC Infectious Diseases1471-23342023-07-012311810.1186/s12879-023-08405-7What clinic closure reveals about care for drug-resistant TB: a qualitative studyThiloshini Govender0Jennifer J. Furin1Alex Edwards2Selvan Pillay3Richard A. Murphy4King Dinizulu Hospital CenterHarvard Medical SchoolEmory University School of Medicine and Rollins School of Public HealthAdrenergy Research InnovationsGeisel School of Medicine at DartmouthAbstract Background There have been calls for “person-centered” approaches to drug-resistant tuberculosis (DR-TB) care. In 2020, Charles James Hospital in South Africa, which incorporated person-centered care, was closed. Patients were referred mid-course to a centralized, tertiary hospital, providing an opportunity to examine person-centered DR-TB and HIV care from the perspective of patients who lost access to it. Methods The impact of transfer was explored through qualitative interviews performed using standard methods. Analysis involved grounded theory; interviews were assessed for theme and content. Results After switching to the centralized site, patients reported being unsatisfied with losing access to a single clinic and pharmacy where DR-TB, HIV and chronic disease care were integrated. Patients also reported a loss of care continuity; at the decentralized site there was a single, familiar clinician whereas the centralized site had multiple, changing clinicians and less satisfactory communication. Additionally, patients reported more disease-related stigma and less respectful treatment, noting the loss of a “special place” for DR-TB treatment. Conclusion By focusing on a DR-TB clinic closure, we uncovered aspects of person-centered care that were critical to people living with DR-TB and HIV. These perspectives can inform how care for DR-TB is operationalized to optimize treatment retention and effectiveness.https://doi.org/10.1186/s12879-023-08405-7Qualitative researchPatient-centered careDrug-resistant tuberculosisMultidrug-resistant tuberculosisRifampin-resistant tuberculosis |
| spellingShingle | Thiloshini Govender Jennifer J. Furin Alex Edwards Selvan Pillay Richard A. Murphy What clinic closure reveals about care for drug-resistant TB: a qualitative study BMC Infectious Diseases Qualitative research Patient-centered care Drug-resistant tuberculosis Multidrug-resistant tuberculosis Rifampin-resistant tuberculosis |
| title | What clinic closure reveals about care for drug-resistant TB: a qualitative study |
| title_full | What clinic closure reveals about care for drug-resistant TB: a qualitative study |
| title_fullStr | What clinic closure reveals about care for drug-resistant TB: a qualitative study |
| title_full_unstemmed | What clinic closure reveals about care for drug-resistant TB: a qualitative study |
| title_short | What clinic closure reveals about care for drug-resistant TB: a qualitative study |
| title_sort | what clinic closure reveals about care for drug resistant tb a qualitative study |
| topic | Qualitative research Patient-centered care Drug-resistant tuberculosis Multidrug-resistant tuberculosis Rifampin-resistant tuberculosis |
| url | https://doi.org/10.1186/s12879-023-08405-7 |
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