Timire Collins, Kranzer Katharina, Pedrazzoli Debora, Kavenga Fungai, Kasozi Samuel, Mbiba Fredrick, Bond Virginia
Faculty of Infectious & Tropical Diseases, Clinical Research Department, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom.
AIDS & TB Department, Ministry of Health and Child Care, Harare, Zimbabwe.
PLOS Glob Public Health. 2023 Aug 7;3(8):e0001706. doi: 10.1371/journal.pgph.0001706. eCollection 2023.
Households in low-resource settings are more vulnerable to events which adversely affect their livelihoods, including shocks e.g. death of family members, droughts and more recently COVID-19. Drug Resistant Tuberculosis (DR-TB) is 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, 2020-2021. We purposively selected 16 adults who had just completed or were completing treatment for DR-TB for in-depth interviews. We transcribed audio-recordings verbatim and translated the transcripts into English. Data were coded both manually and using NVivo 12 (QSR International), and were analysed thematically. 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. 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 adopted irreversible coping strategies e.g. selling productive assets and withdrawing children from school. DR-TB combined with COVID-19 and other stressors and pushed households into deeper poverty and vulnerability. Multisectoral approaches that combine health systems and socioeconomic 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、干旱等冲击，以及最近的新冠疫情。耐多药结核病（DR-TB）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2020-2021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。我们有目的地挑选了16名刚完成或正在完成耐多药结核病治疗的成年人进行深入访谈。我们逐字转录了录音，并将笔录翻译成英文。数据通过手动编码和使用NVivo 12（QSR国际公司）进行编码，并进行了主题分析。向公共部门以外的医疗服务提供者求医、肺外结核病和卫生系统因素导致耐多药结核病的诊断和治疗延迟，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，即使在治疗完成后仍持续存在。新冠疫情导致的封锁、禽流感和牛病疫情进一步对家庭生计产生了不利影响。在新冠疫情期间常见的耐多药结核病药物短缺，加剧了生产时间的损失和交通成本，因为必须从其他诊所获取药物。可逆的应对策略包括：减少用餐次数；搬迁以寻找照顾者和/或家庭支持；动用储蓄；与学校当局协商让孩子继续上学。一些家庭采取了不可逆转的应对策略，例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源相结合，使家庭陷入更深的贫困和脆弱境地。将卫生系统和社会经济干预措施相结合的多部门方法对于减少诊断延误和痛苦，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。
