The Foundation for Medical Research, Worli, Mumbai, India.
PLoS One. 2019 Jan 17;14(1):e0209924. doi: 10.1371/journal.pone.0209924. eCollection 2019.
The Indian Tuberculosis (TB) Programme currently faces the dual challenges of tackling increasing numbers of drug resistant (DR) TB cases and regulating practices of a pluralistic private sector catering to TB patients. A study of health seeking behaviour of DR-TB patients in such a situation, offers an opportunity to understand the problems patients face while interacting with health systems.
Forty-six DR-TB patients drawn from 15 high TB burden wards in Mumbai were interviewed using an open ended interview tool. Interviews were audio recorded and transcribed. Pathway schematics developed from analysis of patient records, were linked to transcripts. Open coding was used to analyse these units and themes were derived after collating the codes.
The paper presents themes interwoven with narratives in the discussions. These include awareness-action gap among patients, role of neighbourhood providers, responsiveness of health systems, the not-such a 'merry go round' that patients go/are made to go on while seeking care, costs of diagnostics and treatment, and how DR-TB is viewed as the 'big TB'.
The recommendations are based on a preventative ethos which is sustainable, compared to interventions with top-down approaches, which get piloted, but fail to sustain impact when scaled up.
印度结核病（TB）计划目前面临着双重挑战，既要应对不断增加的耐药（DR）TB 病例，又要规范多元化私营部门为 TB 患者提供服务的做法。在这种情况下，对 DR-TB 患者的寻医行为进行研究，为了解患者在与卫生系统互动时所面临的问题提供了机会。
从孟买 15 个高结核病负担病房中抽取了 46 名 DR-TB 患者，使用开放式访谈工具进行了访谈。访谈进行了录音和转录。根据患者记录分析制定的路径示意图与转录本相关联。使用开放式编码对这些单元进行分析，并在整理代码后得出主题。
本文呈现了与讨论交织在一起的主题和叙述。这些主题包括患者之间的意识-行动差距、社区提供者的作用、卫生系统的响应能力、患者在寻求护理时所经历的“并非如此轻松”的过程、诊断和治疗的费用，以及如何将 DR-TB 视为“大结核病”。
这些建议基于可持续的预防理念，与自上而下的干预措施相比，后者虽然进行了试点，但在扩大规模时无法维持影响。
