Patients’ perceptions regarding multidrug-resistant tuberculosis and barriers to seeking care in a priority city in Brazil during COVID-19 pandemic: A qualitative study

Abstract

This study aimed to analyze the discourses of patients who were diagnosed with multidrug-resistant tuberculosis, the perception of why they acquired this health condition and barriers to seeking care in a priority city in Brazil during the COVID-19 pandemic. This was an exploratory qualitative study, which used the theoretical-methodological framework of the Discourse Analysis of French matrix, guided by the Consolidated Criteria for Reporting Qualitative Research. The study was conducted in Ribeirão Preto, São Paulo, Brazil. Seven participants were interviewed who were undergoing treatment at the time of the interview. The analysis of the participants’ discourses allowed the emergence of four discursive blocks: (1) impact of the social determinants in the development of multidrug-resistant tuberculosis, (2) barriers to seeking care and difficulties accessing health services, (3) perceptions of the side effects and their impact on multidrug-resistant tuberculosis treatment, and (4) tuberculosis and COVID-19: a necessary dialogue. Through discursive formations, these revealed the determinants of multidrug-resistant tuberculosis. Considering the complexity involved in the dynamics of multidrug-resistant tuberculosis, advancing in terms of equity in health, that is, in reducing unjust differences, is a challenge for public policies, especially at the current moment in Brazil, which is of accentuated economic, political and social crisis. The importance of psychosocial stressors and the lack of social support should also be highlighted as intermediary determinants of health. The study has also shown the situation of COVID-19, which consists of an important barrier for patients seeking care. Many patients reported fear, insecurity and worry with regard to returning to medical appointments, which might contribute to the worsening of tuberculosis in the scenario under study.

Between Curing and Torturing: Burden of Adverse Reaction in Drug-Resistant Tuberculosis Therapy

“… 31 , 39–42 Although the treatment itself is free, patients still have to pay some indirect cost, for example transportation cost. 43 …”

Causes of multidrug-resistant tuberculosis from the perspectives of health providers: challenges and strategies for adherence to treatment during the COVID-19 pandemic in Brazil

“…Santos and colleagues [35] conclude in their study that the influence of socioeconomic factors on adherence to monitoring and treatment of MDR-TB is evident even when the treatment is free, and the absence of social benefits can hinder treatment continuity. However, an offer of such assistance requires that selected health services be more integrated with other social assistance equipment and exemplifies the relationship of organizational and economic accessibility.…”

Tuberculosis forecasting and temporal trends by sex and age in a high endemic city in northeastern Brazil: where were we before the Covid-19 pandemic?

“…This interruption of health services (totally or partially) was mainly in the DOT strategy, which is the most effective resource available for controlling the TB epidemic in settings with limited resources [ 46 , 47 ]. Another critical situation is the displacement of resources traditionally used in TB to Covid-19 care, such as human resources, diagnostic technologies, spaces, or offices for medical appointments [ 48 ], which impacted TB detection.…”

“…Considering the forecasts, despite the decrease in the detection of the disease before the Covid-19 pandemic, according to the forecasts for the quadrennium 2019 to 2022, in a hypothetic context without the pandemic, the disease would tend to stabilize. This result is really interesting because the social conditions that determined the disease not only appeared in the last 2 years with Covid-19 but also were always present in the lives of patients and their families for generations, and the findings are expressions of this context [ 47 ].…”