title: "When Treatment Is More Challenging than the Disease": A Qualitative Study of MDR-TB Patient Retention.
abstract: BACKGROUND
  One-fifth of the patients on multidrug-resistant tuberculosis treatment at the Drug-Resistant-TB (DR-TB) Site in Gujarat are lost-to-follow-up(LFU).
  
  
  OBJECTIVE
  To understand patients' and providers' perspectives on reasons for LFU and their suggestions to improve retention-in-care.
  
  
  METHODS
  Qualitative study conducted between December 2013-March 2014, including in-depth interviews with LFU patients and DOT-providers, and a focus group discussion with DR-TB site supervisors. A thematic-network analysis approach was utilised.
  
  
  RESULTS
  Three sub-themes emerged: (i) Struggle with prolonged treatment; (ii) Strive against stigma and toward support; (iii) Divergent perceptions and practices. Daily injections, pill burden, DOT, migratory work, social problems, prior TB treatment, and adverse drugs effects were reported as major barriers to treatment adherence and retention-in-care by patients and providers. Some providers felt that despite their best efforts, LFU patients remain. Patient movements between private practitioners and traditional healers further influenced LFU.
  
  
  CONCLUSIONS
  The study points to a need for repeated patient counselling and education, improved co-ordination between various tiers of providers engaged in DR-TB care, collaboration between the public, private and traditional practitioners, and promotion of social and economic support to help patients adhere to MDR-TB treatment and avoid LFU.
authors.affiliation: Department of Preventive Social Medicine, Medical College, Baroda, India.
authors.forename: Kalpita S
authors.initials: KS
authors.lastname: Shringarpure
authors.affiliation: Operational Research Unit, Médecins Sans Frontières, Mumbai, India.
authors.forename: Petros
authors.initials: P
authors.lastname: Isaakidis
authors.affiliation: The Union, South East Asia Office, New Delhi, India.
authors.forename: Karuna D
authors.initials: KD
authors.lastname: Sagili
authors.affiliation: Department of Preventive Social Medicine, Medical College, Baroda, India.
authors.forename: R K
authors.initials: RK
authors.lastname: Baxi
authors.affiliation: Operational Research Unit, Médecins Sans Frontières, Delhi, India.
authors.forename: Mrinalini
authors.initials: M
authors.lastname: Das
authors.affiliation: McGill International TB Centre, McGill University, Montreal, Canada.|Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R. Mandela School of Medicine, University of Kwazulu Natal, Durban, South Africa.|Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
authors.forename: Amrita
authors.initials: A
authors.lastname: Daftary
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010465:Perception; D036301:Qualitative Research; D057545:Social Stigma; D018088:Tuberculosis, Multidrug-Resistant / Q000628:therapy*; D055815:Young Adult