title: The social context of tuberculosis treatment in urban risk groups in the United Kingdom: a qualitative interview study.
abstract: OBJECTIVE
  There is scant qualitative research into the experiences of tuberculosis (TB) treatment in urban risk groups with complex health and social needs in the UK. This study aimed to describe the social context of adherence to treatment in marginalized groups attending a major TB centre in London.
  
  
  METHODS
  A qualitative cross-sectional study was performed using semi-structured interviews with patients receiving treatment for TB. Analytical frameworks aimed to reflect the role of broader social structures in shaping individual health actions.
  
  
  RESULTS
  There were 17 participants; the majority were homeless and had complex medical and social needs, including drug and alcohol use or immigration problems affecting entitlement to social welfare. Participants rarely actively chose not to take their medication, but described a number of social and institutional barriers to adherence and their need for practical support. Many struggled with the physical aspects of taking medication and the side effects. Participants receiving directly observed therapy (DOT) reported both positive and negative experiences, reflecting the type of DOT provider and culture of the organization.
  
  
  CONCLUSIONS
  There is a need for integrated care across drug, alcohol, HIV, and homeless services in order to address the complex clinical co-morbidities and social needs that impact on the patient's ability to sustain a course of treatment.
authors: School of Health Sciences, City University London, Northampton Square, London, EC1 V 0HB, UK. Electronic address: Gill.Craig.1@city.ac.uk.
authors: Gillian M
authors: GM
authors: Craig
authors: Department of Infection, Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, and NIHR Biomedical Research Centre, University College London Hospitals, London, UK.
authors: Alimuddin
authors: A
authors: Zumla
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D023801:Directly Observed Therapy; D005260:Female; D006703:Ill-Housed Persons; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012944:Social Support; D066252:Sociological Factors; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000188:drug therapy* / Q000523:psychology; D006113:United Kingdom; D055815:Young Adult
keywords: Adherence; Drug users; Homeless persons; Social determinants; Stigma; Tuberculosis