Abstract
BackgroundVulnerable individuals with tuberculosis (TB) struggle to access and stay on treatment. While patient-related and social barriers to TB treatment adherence are well documented, less is known about how the organisation and delivery of TB care influences adherence behaviour.AimTo examine the influence of TB service organisation and culture on patients’ experience of starting and staying on treatment in Riga, Latvia.MethodsAn intervention package to support adherence to TB treatment amongst vulnerable patients in Riga, Latvia was piloted between August 2016 and March 2017. Qualitative observations (5), interviews with staff (20) and with TB patients (10) were conducted mid-way and at the end of the intervention to understand perceptions, processes, and experiences of TB care.ResultsThe organisation of TB services is strongly influenced by a divide between medical and social aspects of TB care. Communication and care practices are geared towards addressing individual risk factors for non-adherence rather than the structural vulnerabilities that patients experience in accessing care. Support for vulnerable patients is limited because of standardised programmatic approaches, resource constraints and restricted job descriptions for non-medical staff.ConclusionProviding support for vulnerable patients is challenged in this setting by the strict division between medical and social aspects of TB care, and the organisational focus on patient-related rather than systems-related barriers to access and adherence. Potential systems interventions include the introduction of multi-disciplinary approaches and teams in TB care, strengthening patient literacy at the point of treatment initiation, as well as stronger linkages with social care organisations.
Highlights
The Baltic republic of Latvia is one of 18 high priority countries for tuberculosis (TB) control in the World Health Organization (WHO) European Region, and has a high burden of multidrug-resistant tuberculosis (MDR-TB) [1,2]
Communication and care practices are geared towards addressing individual risk factors for non-adherence rather than the structural vulnerabilities that patients experience in accessing care
This paper reports qualitative findings drawn from a mixed-methods process evaluation of a pilot intervention study that took place between January 2016 and March 2017 in Riga, Latvia under the auspices of the Centre for Tuberculosis and Lung Diseases (CTLD)
Summary
The Baltic republic of Latvia is one of 18 high priority countries for tuberculosis (TB) control in the World Health Organization (WHO) European Region, and has a high burden of multidrug-resistant tuberculosis (MDR-TB) [1,2]. After the collapse of the Soviet Union in the early 1990s, TB rates increased substantially, and only started to decline after 1999, partly due to rapid economic growth in the Baltic region and the adoption of a centralised, strictly followed programmatic approach to management of TB. The TB incidence rate increased again in 2012, coinciding with the global economic crisis that hit Latvia harder than any other EU Member State. Unemployment rates increased, and a large part of the population experienced a decline in socio-economic status and health [4]. While patient-related and social barriers to TB treatment adherence are well documented, less is known about how the organisation and delivery of TB care influences adherence behaviour
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