Such a long journey: What health seeking pathways of patients with drug resistant tuberculosis in Mumbai tell us

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, offer...

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Published in:	PloS one Vol. 14; no. 1; p. e0209924
Main Authors:	Bhattacharya Chakravarty, Aruna, Rangan, Sheela, Dholakia, Yatin, Rai, Sonu, Kamble, Swaran, Raste, Tejaswi, Shah, Sanchi, Shah, Shimoni, Mistry, Nerges
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 17-01-2019 Public Library of Science (PLoS)
Subjects:	Adult Behavior Beliefs, opinions and attitudes Collating Delivery of Health Care Direct reduction Drug resistance Female Health aspects Health behavior Humans Illnesses India - epidemiology Male Medical anthropology Medical diagnosis Medical research Medicine and Health Sciences Microbial drug resistance Patient Acceptance of Health Care Patients People and Places Private sector Public health Qualitative research Researchers Studies Systematic review Tuberculosis Tuberculosis patients Tuberculosis, Multidrug-Resistant - epidemiology Tuberculosis, Multidrug-Resistant - therapy Tuberculosis, Pulmonary - epidemiology Tuberculosis, Pulmonary - therapy India Mumbai India
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Summary:	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.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0209924