Timire Collins, Kranzer Katharina, Pedrazzoli Debora, Kavenga Fungai, Kasozi Samuel, Mbiba Fredrick, Bond Virginia
Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine (LSHTM), London, UK.
AIDS & TB Department, Ministry of Health and Child Care, Harare, Zimbabwe.
medRxiv. 2023 Feb 27:2023.02.24.23286187. doi: 10.1101/2023.02.24.23286187.
Households in low-resource settings are more vulnerable to events which adversely affect their livelihoods, including shocks such as the death of a family member, inflation, droughts and more recently COVID-19. Drug Resistant Tuberculosis (DR-TB) is also another shock that inflicts physical, psychological and socioeconomic burden on individuals and households. We describe experiences and coping strategies among people affected by DR-TB and their households in Zimbabwe during the COVID-19 pandemic, 2020 to 2021.
We conducted 16 in-depth interviews with adults who had just completed or were completing treatment. Interview themes included health seeking behaviour, impact of DR-TB on livelihoods and coping strategies adopted during treatment. We analysed data using thematic analyses.
Health seeking from providers outside the public sector, extra-pulmonary TB and health system factors resulted in delayed DR-TB diagnosis and treatment and increased financial drain on households. DR-TB reduced productive capacity and narrowed job opportunities leading to income loss that continued even after completion of treatment. Household livelihood was further adversely affected by lockdowns due to COVID-19, outbreaks of bird flu and cattle disease. Stockouts of DR-TB medicines, common during COVID-19, exacerbated loss of productive time and transport costs as medication had to be accessed from other clinics that were further away. Reversible coping strategies included: reducing number of meals; relocating in search of caregivers and/or family support; spending savings; negotiating with school authorities to keep children in school. Some households had to adopt irreversible coping strategies such as selling productive assets and withdrawing children from school.
DR-TB combined with COVID-19 and other stressors pushed households into deeper poverty, and vulnerability. Multi-sectoral approaches that combine health systems, psychosocial and economic interventions are crucial to mitigate diagnostic delays and suffering, and meaningfully support people with DR-TB and their households to compensate the loss of livelihoods during and post DR-TB treatment.
资源匮乏地区的家庭更容易受到对其生计产生不利影响的事件的冲击，包括家庭成员死亡、通货膨胀、干旱以及最近的新冠疫情等。耐多药结核病（DR-TB）也是另一种给个人和家庭带来身体、心理和社会经济负担的冲击。我们描述了2020年至2021年新冠疫情期间，津巴布韦受耐多药结核病影响的人群及其家庭的经历和应对策略。
我们对刚完成或正在接受治疗的成年人进行了16次深入访谈。访谈主题包括就医行为、耐多药结核病对生计的影响以及治疗期间采取的应对策略。我们采用主题分析法对数据进行了分析。
向公共部门以外的医疗服务提供者求医、肺外结核病以及卫生系统因素导致耐多药结核病诊断和治疗延迟，并增加了家庭的经济负担。耐多药结核病降低了生产能力，减少了就业机会，导致收入损失，即使在治疗结束后仍持续存在。由于新冠疫情、禽流感和牛病疫情导致的封锁，家庭生计进一步受到不利影响。耐多药结核病药物在新冠疫情期间经常缺货，这加剧了生产时间的损失和交通成本，因为必须从更远的其他诊所获取药物。可逆的应对策略包括：减少用餐次数；搬迁以寻求照顾者和/或家庭支持；动用储蓄；与学校当局协商让孩子继续上学。一些家庭不得不采取不可逆转的应对策略，如出售生产性资产和让孩子辍学。
耐多药结核病与新冠疫情及其他压力因素相结合，使家庭陷入更深的贫困和脆弱境地。结合卫生系统、心理社会和经济干预措施的多部门方法对于减少诊断延迟和痛苦，并切实支持耐多药结核病患者及其家庭弥补耐多药结核病治疗期间及治疗后的生计损失至关重要。
