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"Treatment is of primary importance, and social assistance is secondary": a qualitative study on the organisation of tuberculosis (TB) care and patients' experience of starting and staying on TB treatment in Riga, Latvia
Kielmann, Karina Vidal, Nicole Riekstina, Vija Krutikov, Maria van der Werf, Marieke J. Biraua, Evita Moore, David A.J.
Kielmann, Karina
Vidal, Nicole
Riekstina, Vija
Krutikov, Maria
van der Werf, Marieke J.
Biraua, Evita
Moore, David A.J.
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2018-10-17
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Abstract
Background. Vulnerable individuals with tuberculosis (TB) struggle to access and stay on treatment. While patient-related and social barriers to TB treatment adherence are well documented, less is known about how the organisation and delivery of TB care influences adherence behaviour. Aim To examine the influence of TB service organisation and culture on patients' experience of starting and staying on treatment in Riga, Latvia. Methods An intervention package to support adherence to TB treatment amongst vulnerable patients in Riga, Latvia was piloted between August 2016 and March 2017. Qualitative observations (5), interviews with staff (20) and with TB patients (10) were conducted mid-way and at the end of the intervention to understand perceptions, processes, and experiences of TB care. Results The organisation of TB services is strongly influenced by a divide between medical and social aspects of TB care. Communication and care practices are geared towards addressing individual risk factors for non-adherence rather than the structural vulnerabilities that patients experience in accessing care. Support for vulnerable patients is limited because of standardised programmatic approaches, resource constraints and restricted job descriptions for non-medical staff. Conclusion Providing support for vulnerable patients is challenged in this setting by the strict division between medical and social aspects of TB care, and the organisational focus on patientrelated rather than systems-related barriers to access and adherence. Potential systems interventions include the introduction of multi-disciplinary approaches and teams in TB care, strengthening patient literacy at the point of treatment initiation, as well as stronger linkages with social care organisations.
Citation
Kielmann K, Vidal N, Riekstina V, Krutikov M, van der Werf MJ, Biraua E, et al. (2018) "Treatment is of primary importance, and social assistance is secondary": A qualitative study on the organisation of tuberculosis (TB) care and patients' experience of starting and staying on TB treatment in Riga, Latvia. PLoS ONE 13(10): e0203937. https://doi.org/10.1371/journal.pone.0203937
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30332406 (pubmed)
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Journal article
Language
en
Description
© 2018 The Authors. Published by PLoS. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website:
https://doi.org/10.1371/journal.pone.0203937
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ISSN
1932-6203
EISSN
1932-6203
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This research was funded through the European Centre for Disease Prevention & Control (ECDC project ID OCS-2015-0UT-2900-MCSaAI) and managed by the World Health Communication Associates.
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Licence for published version: Creative Commons Attribution 4.0 International