Bieh Kingsley Lezor, Weigel Ralf, Smith Helen
State TB and Leprosy Control Programme, Rivers State Ministry of Health, Port Harcourt, Nigeria.
Liverpool School of Tropical Medicine, Liverpool, UK.
BMC Infect Dis. 2017 Jan 10;17(1):50. doi: 10.1186/s12879-016-2114-x.
In Nigeria multidrug-resistant tuberculosis (MDR-TB) is prevalent in 2.9% of new TB cases and 14% of retreatment cases, and the country is one of 27 with high disease burden globally. Patients are admitted and confined to one of ten MDR-TB treatment facilities throughout the initial 8 months of treatment. The perspectives of MDR-TB patients shared on social media and in academic research and those of providers are limited to experiences of home-based care. In this study we explored the views of hospitalised MDR-TB patients and providers in one treatment facility in Nigeria, and describe how their experiences are linked to accessibility of care and support services, in line with international goals. We aimed to explore the physical, social and psychological needs of hospitalized MDR TB patients, examine providers' perceptions about the hospital based model and discuss the model's advantages and disadvantages from the patient and the provider perspective.
We conducted two gender distinct focus group discussions and 11 in-depth interviews with recently discharged MDR-TB patients from one MDR-TB treatment facility in Nigeria. We triangulated this with the views of four providers who played key roles in the management of MDR-TB patients via key informant interviews. Transcribed data was thematically analysed, using an iterative process to constantly compare and contrast emerging themes across the data set for deeper understanding of the full range of participants' views.
The study findings demonstrate the psycho-social impacts of prolonged isolation and the coping mechanisms of patients in the facility. The dislocation of patients from their normal social networks and the detachment between providers and patients created the need for interdependence of patients for emotional and physical support. Providers' fears of infection contributed to stigma and hindered accessibility of care and support services.
The current trend towards discharging patients after culture conversion would reduce the psycho-social impacts of prolonged isolation and potentially reduce the risk of occupational TB from prolonged contact with MDR-TB patients. Building on shared experiences and interdependence of MDR-TB patients in our study, innovative patient-centred support systems would likely help to reduce stigma, promote access to care and support services, and potentially impact on the outcome of treatment.
在尼日利亚，耐多药结核病（MDR-TB）在2.9%的新结核病病例和14%的复治病例中流行，该国是全球27个疾病负担较高的国家之一。在治疗的最初8个月里，患者被收治并被限制在十个耐多药结核病治疗机构中的一个。耐多药结核病患者在社交媒体、学术研究中分享的观点以及医护人员的观点仅限于家庭护理的经历。在本研究中，我们探讨了尼日利亚一家治疗机构中住院的耐多药结核病患者和医护人员的观点，并根据国际目标描述了他们的经历与医疗和支持服务可及性之间的联系。我们旨在探讨住院耐多药结核病患者的身体、社会和心理需求，审视医护人员对基于医院模式的看法，并从患者和医护人员的角度讨论该模式的优缺点。
我们对来自尼日利亚一家耐多药结核病治疗机构的近期出院的耐多药结核病患者进行了两场按性别区分的焦点小组讨论和11次深入访谈。我们通过关键信息人访谈，将其与在耐多药结核病患者管理中发挥关键作用的四名医护人员的观点进行了三角互证。对转录的数据进行了主题分析，采用迭代过程不断比较和对比数据集中出现的主题，以更深入地理解所有参与者的观点。
研究结果表明了长期隔离对心理社会的影响以及患者在机构中的应对机制。患者与正常社交网络的脱节以及医护人员与患者之间的疏离导致患者在情感和身体支持方面需要相互依赖。医护人员对感染的恐惧导致了污名化，并阻碍了医疗和支持服务的可及性。
目前在培养结果转阴后让患者出院的趋势将减少长期隔离对心理社会的影响，并有可能降低因与耐多药结核病患者长期接触而感染职业性结核病的风险。基于我们研究中耐多药结核病患者的共同经历和相互依赖，创新的以患者为中心的支持系统可能有助于减少污名化，促进获得医疗和支持服务，并有可能影响治疗结果。
