Vanqa, Nosivuyile, Hoddinott, Graeme, Mbenyana, Baxolele, Osman, Muhammad ORCID: 0000-0003-3818-9729 and Meehan, Sue-Ann (2021) Linkage to TB care: a qualitative study to understand linkage from the patients' perspective in the Western Cape Province, South Africa. PloS one, 16 (11):e0260200. ISSN 1932-6203 (Online) (doi:https://doi.org/10.1371/journal.pone.0260200)

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Abstract

BACKGROUND
Delayed linkage to tuberculosis (TB) treatment leads to poor patient outcomes and increased onward transmission. Between 12% and 25% of people diagnosed with TB are never linked to a primary health care facility for continued care. The TB health program is for creating processes that promote and facilitates easy access to care. We explored how TB patients experience TB services and how this influenced their choices around linkage to TB care and treatment.
METHODS
We enrolled 20 participants routinely diagnosed with TB in hospital or at primary health care facilities (PHC) in a high TB/HIV burdened peri-urban community in South Africa. Using the Western Cape Provincial Health Data centre (PHDC) which consolidates person-level clinical data, we used dates of diagnosis and treatment initiation to select participants who had been linked (immediately, after a delay, or never). Between June 2019 and January 2020, we facilitated in-depth discussions to explore both the participants' experience of their TB diagnosis and their journey around linking to TB care at a primary health care facility. We analysed the data using case descriptions.
RESULTS
Twelve of twenty (12/20) participants interviewed who experienced a delay linking were diagnosed at the hospital. Participants who experienced delays in linking or never linked explained this as a result of lack of information and support from health care providers. Unpleasant previous TB treatment episodes made it difficult to 'face' TB again and being uncertain of their TB diagnosis. In contrast, participants said the main motivator for linking was a personal will to get better.
CONCLUSION
The health care system, especially in hospitals, should focus on strengthening patient-centred care. Communication and clear messaging on TB processes is key, to prepare patients in transitioning from a hospital setting to PHC facilities for continuation of care. This should not just include a thorough explanation of their TB diagnosis but ensure that patients understand treatment processes. Former TB patients may require additional counselling and support to re-engage in care.

Item Type:	Article
Uncontrolled Keywords:	linkage to care; patients' perspective
Subjects:	H Social Sciences > H Social Sciences (General) Q Science > QR Microbiology > QR355 Virology R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Vulnerable Children and Families Faculty of Education, Health & Human Sciences > School of Human Sciences (HUM)
Last Modified:	22 Jun 2022 09:50
URI:	http://gala.gre.ac.uk/id/eprint/36749

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