Objective:

Rising incidence of acquired multidrug-resistant tuberculosis (MDR-TB) in South Africa suggests low knowledge and implementation of infection prevention and control strategies in household and congregate settings. This study contributes to the under-researched area of non-biomedical responses to sub-adherence to treatment.

Design:

The study utilises a quasi-ethnographic qualitative case study of 10 women aged 18 to 34 years to understand their treatment adherence behaviours through the lens of their sex, gender, age, cultural beliefs and socio-economic status.

Setting:

This study investigated reasons for young women’s sub-optimal adherence to treatment for acquired MDR-TB in eThekwini Metro, KwaZulu-Natal province, South Africa, which records high burdens of tuberculosis (TB), MDR-TB and HIV.

Methods:

Primary data were collected from 20 participants who were selected through criterion, purposive and snowball sampling. Data were gathered through focus group discussions with women being treated for transmitted MDR-TB and key informant interviews with their family members, health workers and KwaZulu-Natal Provincial Department of Health personnel.

Results:

Anti-MDR-TB treatment affects women’s sexuality, intimate relationships, family planning intentions and reproductive health. Some vulnerable women struggle to persevere on noxious and lengthy treatment regimes that affect their reproductive and psychological health. Women may skip doses or abandon treatment when high pill burdens and adverse events make intimate and sexual relations with male partners, on whom they may depend for their livelihoods, difficult.

Conclusion:

It is important to consider the effects of lengthy treatment on young people’s social and sexual lives and self-esteem when (re)designing MDR-TB counselling approaches. This paper advances an evidence-based treatment education and counselling strategy to contribute to improving MDR-TB treatment adherence and success.

中文翻译：

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南非的爱、性、毒品和妇女对耐多药结核病治疗的依从性不佳：加强健康教育的机会

客观的：

南非获得性耐多药结核病 (MDR-TB) 发病率上升表明家庭和聚集环境中感染预防和控制策略的知识和实施不足。这项研究有助于对治疗依从性不足的非生物医学反应这一研究不足的领域。

设计：

该研究利用 10 名 18 至 34 岁女性的准人种学定性案例研究，通过她们的性别、性别、年龄、文化信仰和社会经济地位来了解她们的治疗依从性行为。

环境：

本研究调查了南非夸祖鲁-纳塔尔省 eThekwini Metro 年轻女性对获得性耐多药结核病治疗依从性不佳的原因，该地区记录了结核病 (TB)、耐多药结核病和艾滋病毒的高负担。

方法：

主要数据是从通过标准、目的和滚雪球抽样选出的 20 名参与者中收集的。数据是通过与接受 MDR-TB 传播治疗的妇女的焦点小组讨论以及与她们的家人、卫生工作者和夸祖鲁-纳塔尔省卫生厅工作人员的主要知情人面谈来收集的。

结果：

抗耐多药结核病治疗影响妇女的性行为、亲密关系、计划生育意图和生殖健康。一些易受伤害的妇女在影响其生殖和心理健康的有害且冗长的治疗方案中挣扎着坚持下去。当高药丸负担和不良事件导致与男性伴侣的亲密关系和性关系变得困难时，女性可能会跳过剂量或放弃治疗，而她们的生计可能依赖男性。

结论：

在（重新）设计 MDR-TB 咨询方法时，重要的是要考虑长期治疗对年轻人的社交和性生活以及自尊的影响。本文提出了一种循证治疗教育和咨询策略，有助于提高耐多药结核病治疗的依从性和成功率。