(Re)positioning communication for enhanced multidrug-resistant tuberculosis treatment adherence in South Africa: towards an integrated communication model for young women.
Mugoni, Petronella Chipo.
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Tuberculosis (TB) is a significant public health threat in South Africa, which has been the leading cause of natural mortality over many years (Statistics South Africa 2018; Statistics South Africa 2017; ENCA 2015a). Although TB has been largely eradicated in the Global North and available literature explains how this was achieved, in developing countries like South Africa incidence of not only TB, but drug-resistant forms of the disease continue to grow (Shah et al. 2017). There are many explanations for these trends, including unavailability of less noxious anti-TB medications, serious side effects and lengthy treatment timelines, drug stock-outs, context-determined structural, socioeconomic, cultural and gender-based barriers to treatment adherence and inadequate or ineffective patient and community education about the disease (Shringarpure et al. 2016). Concerns occur on the backdrop of health systems that overly privilege biomedical responses to TB, to the detriment of all other interventions. Scholars protest that ‘The TB literature is written almost entirely from a biomedical perspective, while recent studies show that it is imperative to understand lay perceptions to determine why people who seek treatment may stop taking treatment’ (Cramm et al. 2010:2). Extant literature acknowledges the unsuitability, on its own, of the biomedical approach to reducing burdens of TB in epidemic countries like South Africa (Daftary et al. 2015). This recognition is accompanied by impetus to develop and apply theory-based strategies to encourage long-term adherence to TB treatment. Scholars insist that there are several health behaviour theories with potential to improve understanding in this area (Daftary et al. 2015; Munro et al. 2007). This research responds to the question of how health communication and promotion strategies can practically contribute to improving multidrug-resistant TB (MDR-TB) treatment adherence and clinical outcomes among a defined vulnerable population in KwaZulu-Natal province, South Africa. It aims to contribute knowledge to the under-researched area of non-biomedical responses to sub-optimal adherence to long-term DR-TB treatment in high TB/HIV burden areas (O’Donnell et al. 2017). Primary qualitative data was collected through focus group discussions and key respondent interviews with 20 purposefully selected participants in eThekwini Metro, KwaZulu-Natal, from March to September 2018. Ten of the participants comprised the case study of this research; culture-sharing young women, many of them isiZulu-speaking, aged 18 to 34 years from low socioeconomic communities being treated for MDR-TB at one public hospital in the Metro. The study proposes a ‘how to’ for MDR-TB health promotion in high burden areas. vii It finds that vulnerable young women's sub-optimal adherence to MDR-TB treatment is exacerbated by patriarchy, stigma and cultural beliefs and practices. Culturally prescribed family collaborative approaches to health-seeking among Zulu people urge for the incorporation of female elders, intimate male partners and older children into young women’s treatment. In contexts like eThekwini Metro where many MDR-TB patients demonstrate strong cultural beliefs and practices, emphasising biomedical treatment for individual patients as the denominator of treatment requires reconsideration. Findings also suggest that MDR-TB programmes would benefit from borrowing from HIV communication interventions by implementing standardised individual, couples’ and family counselling at intervals during the nine to 36 months of treatment to enhance patients’ adherence. Consideration should also be given to engaging traditional health practitioners as important partners in health promotion. Further, educating patients and communities about MDR-TB treatment should be bolstered through health promotion and communication via school curricula, culturally proximate television and radio (soap operas, dramas and hard news) programmes and Facebook and WhatsApp. Social media is important because it allows for low-cost group, one-on-one and anonymous exchanges and discussions of health information.