title: Pilot study to develop a rapid assessment of tuberculosis care-seeking and adherence practices in rural Limpopo Province, South Africa.
abstract: Studies of factors influencing tuberculosis (TB) care-seeking and treatment adherence in high TB/HIV co-burden African countries have typically surveyed urban patients' sociodemographic characteristics. To understand community perceptions and guide rapid assessment interviews, we interviewed key informants (nurses, tribal leaders, n = 9) and local researchers (n = 3) in poor, rural areas of South Africa. HIV-related stigma and misperceptions about TB causes and symptoms were cited as barriers. Key informants said older people preferred traditional healers; local researchers heard a preference for "western" care and suggested supporting clinic staff travel to remote villages with health education and diagnostic services. Key informants said not understanding the consequences of incomplete treatment and reluctance to relinquish disability grants decreased adherence. All reported that nonfamily DOTS supporters provided invaluable support. Rapid assessment should include drop-outs, re-treated, and co-infected patients and ask questions examining origins of misperceptions, stigma of testing, and pre-test messages to improve community perceptions about TB care-seeking and treatment adherence.
authors.affiliation: School of Public Health, University of Texas, Houston, USA. rfinnie@asu.edu
authors.forename: Ramona K C
authors.initials: RK
authors.lastname: Finnie
authors.forename: Tiyane
authors.initials: T
authors.lastname: Mabunda
authors.forename: Lunic Base
authors.initials: LB
authors.lastname: Khoza
authors.forename: Bart
authors.initials: B
authors.lastname: van den Borne
authors.forename: Beatrice
authors.initials: B
authors.lastname: Selwyn
authors.forename: Patricia Dolan
authors.initials: PD
authors.lastname: Mullen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D007722:Health Knowledge, Attitudes, Practice; D006302:Health Services Research / Q000379:methods; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010865:Pilot Projects; D012423:Rural Health; D057545:Social Stigma; D013019:South Africa; D014376:Tuberculosis / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D055815:Young Adult