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‘I cry every day’: experiences of patients co‐infected with HIV and multidrug‐resistant tuberculosis
Author(s) -
Isaakidis Petros,
Rangan Sheela,
Pradhan Anagha,
Ladomirska Joanna,
Reid Tony,
Kielmann Karina
Publication year - 2013
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.12146
Subject(s) - medicine , tuberculosis , context (archaeology) , social support , social stigma , human immunodeficiency virus (hiv) , mental health , stigma (botany) , qualitative research , family medicine , psychiatry , psychology , paleontology , social science , pathology , sociology , psychotherapist , biology
Objectives To understand patients' challenges in adhering to treatment for MDR ‐ TB / HIV co‐infection within the context of their life circumstances and access to care and support. Methods Qualitative study using in‐depth interviews with 12 HIV / MDR ‐ TB co‐infected patients followed in a M édecins S ans F rontières ( MSF ) clinic in Mumbai, India, five lay caregivers and ten health professionals. The data were thematically analysed along three dimensions of patients' experience of being and staying on treatment: physiological, psycho‐social and structural. Results By the time patients and their families initiate treatment for co‐infection, their financial and emotional resources were often depleted. Side effects of the drugs were reported to be severe and debilitating, and patients expressed the burden of care and stigma on the social and financial viability of the household. Family caregivers were crucial to maintaining the mental and physical health of patients, but reported high levels of fatigue and stress. M édecins S ans F rontières providers recognised that the barriers to patient adherence were fundamentally social, rather than medical, yet were limited in their ability to support patients and their families. Conclusions The treatment of MDR ‐ TB among HIV ‐infected patients on antiretroviral therapy is hugely demanding for patients, caregivers and families. Current treatment regimens and case‐holding strategies are resource intensive and require high levels of support from family and lay caregivers to encourage patient adherence and retention in care.