"Take the treatment and be brave": Care experiences of pregnant women with rifampicin-resistant tuberculosis.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Social Support*; Mothers/*psychology ; Pregnant Women/*psychology ; Tuberculosis, Multidrug-Resistant/*psychology ; Tuberculosis, Pulmonary/*psychology; Adult ; Antitubercular Agents/therapeutic use ; Courage ; Female ; Humans ; Infant ; Mycobacterium tuberculosis/pathogenicity ; Patient Satisfaction/statistics & numerical data ; Pregnancy ; Qualitative Research ; Rifampin/therapeutic use ; Social Identification ; South Africa ; Surveys and Questionnaires ; Tuberculosis, Multidrug-Resistant/drug therapy ; Tuberculosis, Multidrug-Resistant/microbiology ; Tuberculosis, Multidrug-Resistant/pathology ; Tuberculosis, Pulmonary/drug therapy ; Tuberculosis, Pulmonary/microbiology ; Tuberculosis, Pulmonary/pathology

Background: There are few data on the on the care experiences of pregnant women with rifampicin-resistant TB.
Objective: To describe the treatment journeys of pregnant women with RR-TB-including how their care experiences shape their identities-and identify areas in which tailored interventions are needed.
Methods: In this qualitative study in-depth interviews were conducted among a convenience sample from a population of pregnant women receiving treatment for RR-TB. This paper follows COREQ guidelines. A thematic network analysis using an inductive approach was performed to analyze the interview transcripts and notes. The analysis was iterative and a coding system developed which focused on the care experiences of the women and how these experiences affected their perceptions of themselves, their children, and the health care system in which treatment was received.
Results: Seventeen women were interviewed. The women described multiple challenges in their treatment journeys which required them to demonstrate sustained resilience (i.e. to "be brave"). Care experiences required them to negotiate seemingly contradictory identities as both new mothers-"givers of life"-and RR-TB patients facing a complicated and potentially deadly disease. In terms of their "pregnancy identity" and "RR-TB patient identity" that emerged as part of their care experiences, four key themes were identified that appeared to have elements that were contradictory to one another (contradictory areas). These included: 1) the experience of physical symptoms or changes; 2) the experience of the "mothering" and "patient" roles; 3) the experience of the care they received for their pregnancy and their RR-TB; and 4) the experience of community engagement. There were also three areas that overlapped with both roles and during which identity was negotiated/reinforced and they included: 1) faith; 2) socioeconomic issues; and 3) long-term concerns over the child's health. At times, the health care system exacerbated these challenges as the women were not given the support they needed by health care providers who were ill-informed or angry and treated the women in a discriminatory fashion. Left to negotiate this confusing time period, the women turned to faith, their own mothers, and the fathers of their unborn children.
Conclusion: The care experiences of the women who participated in this study highlight several gaps in the current health care system that must be better addressed in both TB and perinatal services in order to improve the therapeutic journeys for pregnant women with RR-TB and their children. Suggestions for optimizing care include the provision of integrated services, including specialized counseling as well as training for health care providers; engagement of peer support networks; provision of socioeconomic support; long-term medical care/follow-up for children born to women who were treated for RR-TB; and inclusion of faith-based services in the provision of care.
Competing Interests: The authors have declared that no competing interests exist.

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0 (Antitubercular Agents)
VJT6J7R4TR (Rifampin)

Date Created: 20201221 Date Completed: 20210118 Latest Revision: 20210118

20221213

PMC7751874

10.1371/journal.pone.0242604

33347448