Médecins Sans Frontières, Minsk, Belarus.
Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
BMC Health Serv Res. 2022 Sep 30;22(1):1217. doi: 10.1186/s12913-022-08525-x.
Tuberculosis (TB) often concentrates in groups of people with complex health and social issues, including alcohol use disorders (AUD). Risk of TB, and poor TB treatment outcomes, are substantially elevated in people who have AUD. Médecins sans Frontières and the Belarus Ministry of Health have worked to improve treatment adherence in patients with multi-drug or rifampicin resistant (MDR/RR)-TB and harmful use of alcohol. In 2016, a person-centred, multidisciplinary, psychosocial support and harm reduction programme delivered by TB doctors, counsellors, psychiatrists, health-educators, and social workers was initiated. In 2020, we described patient and provider experiences within the programme as part of a wider evaluation.
We recruited 12 patients and 20 health-care workers, using purposive sampling, for in-depth individual interviews and focus group discussions. We used a participant-led, flexible, exploratory approach, enabling participants and the interviewer to shape topics of conversation. Qualitative data were coded manually and analysed thematically. As part of the analysis process, identified themes were shared with health-care worker participants to enable their reflections to be incorporated into the findings.
Key themes related to the patients' and practitioners experience of having and treating MDRTB with associated complex health and social issues were: fragility and despair and guidance, trust and health. Prejudice and marginalisation were global to both themes. Counsellors and other health workers built a trusting relationship with patients, enabling guidance through a multi-disciplinary approach, which supported patients to achieve their vision of health. This guidance was achieved by a team of social workers, counsellors, doctors and health-educators who provided professional and individualised help for patients' illnesses, personal or interpersonal problems, administrative tasks, and job searches.
Patients with MDR/RR-TB and harmful use of alcohol faced complex issues during treatment. Our findings describe how person-centred, multi-disciplinary, psychosocial support helped patients in this setting to cope with these challenges and complete the treatment programme. We recommend that these findings are used to: i) inform programmatic changes to further boost the person-centred care nature of this program; and ii) advocate for this type of person-centred care approach to be rolled out across Belarus, and in contexts that face similar challenges.
结核病（TB）常集中于存在复杂健康和社会问题的人群中，包括酒精使用障碍（AUD）。患有 AUD 的人患结核病的风险以及结核病治疗效果不佳的风险显著增加。无国界医生组织和白俄罗斯卫生部已努力提高耐多药/利福平耐药（MDR/RR）-TB 和酒精滥用患者的治疗依从性。2016 年，启动了一项由结核病医生、咨询师、精神科医生、健康教育者和社会工作者实施的以患者为中心、多学科、心理社会支持和减少伤害的方案。2020 年，我们在更广泛的评估中描述了该方案内的患者和提供者的经验。
我们使用目的抽样招募了 12 名患者和 20 名卫生保健工作者进行深入的个人访谈和焦点小组讨论。我们采用以参与者为主导、灵活、探索性的方法，使参与者和访谈者能够塑造对话主题。定性数据进行手动编码并进行主题分析。在分析过程中，将确定的主题与卫生保健工作者参与者分享，以纳入他们的想法。
与 MDRTB 相关的复杂健康和社会问题的患者和从业者的经验主要包括：脆弱和绝望与指导、信任与健康。偏见和边缘化在两个主题中都是全球性的。咨询师和其他卫生工作者与患者建立了信任关系，通过多学科方法进行指导，使患者能够实现他们的健康愿景。这种指导是由一组社会工作者、咨询师、医生和健康教育者完成的，他们为患者的疾病、个人或人际关系问题、行政任务和求职提供专业和个性化的帮助。
耐多药/利福平耐药（MDR/RR）-TB 且有酒精滥用的患者在治疗期间面临复杂问题。我们的研究结果描述了以患者为中心、多学科的心理社会支持如何帮助这种情况下的患者应对这些挑战并完成治疗方案。我们建议将这些发现用于：i）告知方案的改变，以进一步增强该方案以人为本的关怀性质；ii）倡导在白俄罗斯和面临类似挑战的环境中推广这种以人为本的关怀方法。
