Patients’ perceptions regarding multidrug-resistant tuberculosis and barriers to seeking care in a priority city in Brazil during COVID-19 pandemic: A qualitative study
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...
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| Published in | PloS one Vol. 16; no. 4; p. e0249822 |
|---|---|
| Main Authors | , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Public Library of Science
09.04.2021
Public Library of Science (PLoS) |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1932-6203 1932-6203 |
| DOI | 10.1371/journal.pone.0249822 |
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| 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. |
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| AbstractList | 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. 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.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. According to the World Health Organization (WHO), there were an estimated 465,000 cases of MDR-TB in 2019, equivalent to 11% of the total number of cases of TB worldwide. According to the latest data reported in MDR-TB annual cohorts, of those affected by the disease who started treatment for MDR-TB, only 57% completed the treatment successfully, 16% were lost to follow-up, 7% had treatment that failed, and 15% died, while for 5% there was no outcome information [1]. According to Orenstein and colleagues [6], treatment success occurs in approximately 50% of cases, while deaths and abandonments reach 24%, which are drastically lower values when compared to treatments for sensitive TB. According to the WHO, people affected by MDR-TB spend up to 20 times more compared to people affected by drug-sensitive TB [9]; it is worth mentioning that the investment of families with treatment is generally above 20% of the annual family income, which has an impact on families with less purchasing power [10]. According to the World Health Organization (WHO), there were an estimated 465,000 cases of MDR-TB in 2019, equivalent to 11% of the total number of cases of TB worldwide. According to the latest data reported in MDR-TB annual cohorts, of those affected by the disease who started treatment for MDR-TB, only 57% completed the treatment successfully, 16% were lost to follow-up, 7% had treatment that failed, and 15% died, while for 5% there was no outcome information [1]. According to Orenstein and colleagues [6], treatment success occurs in approximately 50% of cases, while deaths and abandonments reach 24%, which are drastically lower values when compared to treatments for sensitive TB. According to the WHO, people affected by MDR-TB spend up to 20 times more compared to people affected by drug-sensitive TB [9]; it is worth mentioning that the investment of families with treatment is generally above 20% of the annual family income, which has an impact on families with less purchasing power [10]. |
| Audience | Academic |
| Author | Bruce, Alexandre Tadashi Inomata Costa, Fernanda Bruzadelli Paulino da Souza, Ludmilla Leidianne Limirio Pinto, Ione Carvalho Arcêncio, Ricardo Alexandre Crispim, Juliane de Almeida Martoreli Júnior, José Francisco Arroyo, Luiz Henrique Santos, Felipe Lima dos Alves, Yan Mathias Berra, Thaís Zamboni Scholze, Alessandro Rolim Moncaio, Ana Carolina Scarpel Ramos, Antônio Carlos Vieira |
| AuthorAffiliation | 1 Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil 2 Department of Nursing, Federal University of Catalão, Catalão, Goiás, Brazil National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, ITALY |
| AuthorAffiliation_xml | – name: National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, ITALY – name: 1 Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil – name: 2 Department of Nursing, Federal University of Catalão, Catalão, Goiás, Brazil |
| Author_xml | – sequence: 1 givenname: Felipe Lima dos orcidid: 0000-0001-5606-9478 surname: Santos fullname: Santos, Felipe Lima dos – sequence: 2 givenname: Ludmilla Leidianne Limirio surname: Souza fullname: Souza, Ludmilla Leidianne Limirio – sequence: 3 givenname: Alexandre Tadashi Inomata surname: Bruce fullname: Bruce, Alexandre Tadashi Inomata – sequence: 4 givenname: Juliane de Almeida surname: Crispim fullname: Crispim, Juliane de Almeida – sequence: 5 givenname: Luiz Henrique surname: Arroyo fullname: Arroyo, Luiz Henrique – sequence: 6 givenname: Antônio Carlos Vieira surname: Ramos fullname: Ramos, Antônio Carlos Vieira – sequence: 7 givenname: Thaís Zamboni surname: Berra fullname: Berra, Thaís Zamboni – sequence: 8 givenname: Yan Mathias orcidid: 0000-0002-5596-0047 surname: Alves fullname: Alves, Yan Mathias – sequence: 9 givenname: Alessandro Rolim surname: Scholze fullname: Scholze, Alessandro Rolim – sequence: 10 givenname: Fernanda Bruzadelli Paulino da surname: Costa fullname: Costa, Fernanda Bruzadelli Paulino da – sequence: 11 givenname: José Francisco surname: Martoreli Júnior fullname: Martoreli Júnior, José Francisco – sequence: 12 givenname: Ana Carolina Scarpel orcidid: 0000-0002-4124-5173 surname: Moncaio fullname: Moncaio, Ana Carolina Scarpel – sequence: 13 givenname: Ione Carvalho surname: Pinto fullname: Pinto, Ione Carvalho – sequence: 14 givenname: Ricardo Alexandre surname: Arcêncio fullname: Arcêncio, Ricardo Alexandre |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33836024$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Copyright | COPYRIGHT 2021 Public Library of Science 2021 Santos et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2021 Santos et al 2021 Santos et al |
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| SubjectTerms | Adult Aged Brazil Brazil - epidemiology Care and treatment Complications and side effects Coronaviruses COVID-19 COVID-19 - epidemiology Disease transmission Drug resistance Drug resistance in microorganisms Epidemics Female Health services Health Services Accessibility Humans Low income groups Male Medical treatment Medicine and Health Sciences Middle Aged Multidrug resistance Multidrug resistant organisms Nursing Pandemics Patient Acceptance of Health Care Patients People and places Political aspects Poverty Psychological aspects Public health Qualitative research SARS-CoV-2 Social aspects Tuberculosis Tuberculosis, Multidrug-Resistant - epidemiology Tuberculosis, Multidrug-Resistant - therapy Young Adult |
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| Title | Patients’ perceptions regarding multidrug-resistant tuberculosis and barriers to seeking care in a priority city in Brazil during COVID-19 pandemic: A qualitative study |
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