Specific Interventions for Implementing a Patient-Centered Approach to TB Care in Low-Incidence Cities

Abstract

Background: According to the latest Guidelines from the World Health Organization, there is an increasing need for patient-centered tuberculosis disease management given the socio-economic factors influencing the tuberculosis epidemic. In the present study, we aimed to study TB in Barcelona city from an anthropological point of view and to devise a series of specific proposals to implement a patient-centered approach in our setting.Methods: We carried out a qualitative study using an anthropological approach in Barcelona in the period between November 2017 and November 2018 and proposed specific interventions based on our observations.Results: In practice, in our environment (a low-incidence European country where tuberculosis tends to present in patients with multiple social problems), and despite the goodwill of the care teams, there are no established and stable circuits, or specific tools to ensure that this is done routinely. Based on our observations, we have devised a series of specific proposals to implement a patient-centered approach. With these interventions we aim to (a) directly ameliorate TB patients well-being in any diagnostic/healthcare management center and (b) at more general level, to increase TB detection and treatment adherence.Conclusions: The patient-centered TB management recommended by the WHO might be essential for patients' well-being, but there is a lack of circuits or working protocols that ensure its implementation in a regulated manner. In the present manuscript we explain the various concrete measures that we propose in our region and which could be put into practice in other cities or geographic regions with similar epidemiological characteristics.

Relational Dynamics of Treatment Behavior Among Individuals with Tuberculosis in High-Income Countries: A Scoping Review

“…Social support - or the lack of it – was an important determinant of knowledge about TB, the experience of having TB, and the ability to access and stay on treatment. Lack of social support was particularly acute in marginalized groups, including migrants; 26 , 29 , 33 aboriginal or indigenous groups; 35 , 36 , 39 and people who used drugs. 26 For many of these individuals, living in urban areas without family support exacerbated social isolation.…”

“…Six papers, focused on the experiences of migrants, cited concerns around legal status in the host country as having negative effects on individuals’ health and treatment-seeking behaviour. 29 , 37 , 44–46 , 48 Immigrants faced language barriers and barriers to employment that in turn affected health literacy and health-seeking behaviour. 29 Fear of deportation or expulsion from the country resulted in mistrust of the health system, which negatively affected treatment-seeking behaviour, 45 , 46 , 48 and also discouraged individuals’ ability to voice an opinion on their treatment experience, as illustrated in one poignant study of Ethiopian and Somali migrants in Norway: People feel that this is not their country and then it is hard to protest.…”

“… 29 , 37 , 44–46 , 48 Immigrants faced language barriers and barriers to employment that in turn affected health literacy and health-seeking behaviour. 29 Fear of deportation or expulsion from the country resulted in mistrust of the health system, which negatively affected treatment-seeking behaviour, 45 , 46 , 48 and also discouraged individuals’ ability to voice an opinion on their treatment experience, as illustrated in one poignant study of Ethiopian and Somali migrants in Norway: People feel that this is not their country and then it is hard to protest. This [DOT] only applies for people coming from the third world [Male patient in Norway, Sagbakken et al, 2012, p.316].…”

“…Studies were conducted in Europe (n=12), North America (n=11), East Asia (n=2), and Australasia (n=3). Six studies 23,[26][27][28][29][30] used a mixedmethods approach, the rest exclusively used qualitative methods. Studies reported on the perspectives of individuals with TB (n=15), community members (n=3), health providers (n=2), or a combination of different population groups (n=8).…”

“You have to change your whole life”: A qualitative study of the dynamics of treatment adherence among adults with tuberculosis in the United Kingdom

“…Despite these studies, there are few data available to help shape evidence-based, supportive approaches for use across the highly diverse populations encountered in high-income, low incidence settings [29] , [30] . The small number of qualitative studies reporting on the experiences of individuals with TB in the UK have focused on sub-populations living in extreme situations or within specific communities [31] , [32] , [33] , [34] .…”