title: Provider perspectives on drug-resistant tuberculosis and human immunodeficiency virus care in South Africa: a qualitative case study.
abstract: To examine influences on health care workers' (HCWs') capacity to deliver health care for multi- and/or extensively drug-resistant tuberculosis (MDR/XDR-TB) and human immunodeficiency virus (HIV) infection in South Africa.
  
  
  
  Qualitative data were collected via group and individual interviews with a purposive sample of 17 HCWs at a centralised, tertiary TB facility and analysed using grounded theory.
  
  
  
  Four themes were identified: 1) personal infection control practices among HCWs may be weakened by a workplace culture comprising low motivation, disparate risk perceptions and practices across workforce hierarchies, physical discomfort, and problems managing patients with treatment-induced hearing loss. 2) Patient-provider interactions are likely stronger among nurses, and in HIV vs. MDR/XDR-TB service delivery, due to greater attention to patient empowerment and support. Stigma associated with MDR/XDR-TB, considered worse than HIV, may be perpetuated within non-specialised facilities less familiar with MDR/XDR-TB. 3) HCWs who struggle with the daily tedium of MDR/XDR-TB treatment supervision are becoming increasingly supportive of treatment literacy and self-administration. 4) Effective integration of HIV and MDR/XDR-TB services may be impeded by administrative restrictions, workplace norms and provider mindsets.
  
  
  
  Comprehensive, decentralised management of MDR/XDR-TB and HIV coinfection requires the creation of patient-provider trust and treatment literacy in MDR/XDR-TB programmes, and defying workplace norms that could provoke nosocomial TB exposure and fragmented service provision.
authors: McGill International TB Centre, McGill University, Montreal, Canada; Centre for the AIDS Programme of Research in South Africa (CAPRISA), SA Medical Research Council Extramural TB Pathogenesis Research Unit, University of KwaZulu-Natal, Durban, South Africa.
authors: A
authors: A
authors: Daftary
authors: Centre for the AIDS Programme of Research in South Africa (CAPRISA), SA Medical Research Council Extramural TB Pathogenesis Research Unit, University of KwaZulu-Natal, Durban, South Africa.
authors: N
authors: N
authors: Padayatchi
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D003695:Delivery of Health Care / Q000458:organization & administration*; D019468:Disease Management; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D057220:Health Literacy; D006282:Health Personnel; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional; D011369:Professional-Patient Relations; D036301:Qualitative Research; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents