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Jan de Lind van Wijngaarden and Gill Fletcher, FHI/Cambodia June 2001

Ideas, attitudes and TB treatment-seeking behavior among AIDS and TB patients in Phnom Penh, Cambodia. Jan de Lind van Wijngaarden and Gill Fletcher, FHI/Cambodia June 2001. Results of qualitative research conducted by FHI/IMPACT and Action/IEC as part of the FHI/Gorgas TB/ERA Project.

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Jan de Lind van Wijngaarden and Gill Fletcher, FHI/Cambodia June 2001

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  1. Ideas, attitudes and TB treatment-seeking behavior among AIDS and TB patients in Phnom Penh, Cambodia Jan de Lind van Wijngaarden and Gill Fletcher, FHI/Cambodia June 2001

  2. Results of qualitative research conducted by FHI/IMPACT and Action/IEC as part of the FHI/Gorgas TB/ERA Project Introduction • This research was carried out to meet two of the TB/ERA project objectives: Assessment of TB burden in vulnerable populations; and the design and production of IEC materials • This presentation will focus on: • TB and AIDS patients • Misconceptions about TB/AIDS, treatment-seeking behavior, stigma and discrimination • Recommendations arising from the research

  3. Research informants • Patients who receive drugs from the DOTS Home Delivery Program in Phnom Penh (N=8) • Patients who attend Cenat to receive drugs as DOTS out-patients (N=7) • Patients under the Home Care Network (HCN) in Phnom Penh (N=16)

  4. Methodology • Individual interviews and observations • Random selection of participants using NTP and Home Care Network patient lists • Cambodian researchers • Tape recorders used

  5. Possible pitfalls • Interviews were carried out in homes and Cenat hospital – confidentiality could not be guaranteed • Researchers were new to the subject of TB – not always sufficient probing • Data analysis conducted in English – some info may have been lost • Sometimes HCN or Cenat staff were present during the interview

  6. Main misconceptions • TB can be transmitted by eating together/sharing plates or other objects • TB can be transmitted by sleeping together/having sex • TB is a hereditary disease • TB can be transmitted by sharing a TB patient’s bathroom • TB is transmitted through dust

  7. Consequences • Self-isolation of patients • Increased risk of stigma and discrimination from the community • Increased confusion between HIV/TB symptoms, transmission modes, treatment and cure

  8. Determinants for seeking treatment • Symptoms: cough and fever • Important function of pharmacists (drug sellers) • Smaller role for traditional healers • Public/private hospitals • Only 2 out of 15 patients on TB treatment started their treatment at the NTP

  9. Most patients knew TB is treatable and curable and that AIDS is not • Stigma and discrimination (‘felt’ rather than ‘enacted’) seems an important obstacle • DOTS patients’ main motivation to continue treatment was that they noticed improvement in their health since enrolling

  10. Consequences • Most patients have had untreated or inappropriately treated TB for a long time before enrolling in DOTS • Potential risk of increased drug resistance • Potential risk for increased transmission due to inappropriate treatment and advice • Discouragement of treatment-seeking in general population

  11. Stigma and discrimination • So far TB seems less stigmatizing than HIV • An increase in TB cases among AIDS patients may change this • ‘Felt’ stigma found frequently, ‘enacted’ stigma less frequently • Spontaneous community support mechanisms exist

  12. Consequences • Negative factor in treatment-seeking behavior • Context of AIDS may worsen this (see: Jintana et al., 2000, in Thailand) • Self-isolation due to felt stigma decreases quality of life of TB patients and family members

  13. Recommendations • IEC materials explaining what TB is, the fact that it is curable, where to go to seek treatment and how to prevent transmission are urgently needed • IEC materials need to be backed by more behavior change communication training for Home Care Network teams and DOTS home delivery program staff

  14. Strategies to diminish discrimination and stigmatization of both TB and AIDS patients must be explored • More research is needed into treatment-seeking behavior of patients with TB in high-prevalence AIDS areas, to monitor the mechanism found in Chiang Rai by Jintana et al. (2000)

  15. As only a small minority of TB patients started their treatment career at NTP, a stronger marketing and publicity strategy is needed for the NTP, in order to position it as a more desirable treatment option for patients with chronic cough • Relationships between the government and organizations working in TB and AIDS care must be strengthened further

  16. Thank you for your attention And thanks to NTP, NCHADS, KHANA, Servants, JICA, and MSF-Ffor their inputs and support

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