Living with tuberculosis: a qualitative study of patients' experiences with disease and treatment.

BACKGROUND: Although tuberculosis (TB) is a curable disease, treatment is complex and prolonged, requiring considerable commitment from patients. This study aimed to understand the common perspectives of TB patients across Brazil, Russia, India, China, and South Africa throughout their disease journey, including the emotional, psychological, and practical challenges that patients and their families face. METHODS: This qualitative market research study was conducted between July 2020 and February 2021. Eight TB patients from each country (n = 40) completed health questionnaires, video/telephone interviews, and diaries regarding their experiences of TB. Additionally, 52 household members were interviewed. Patients at different stages of their TB treatment journey, from a range of socioeconomic groups, with or without TB risk factors were sought. Anonymized data underwent triangulation and thematic analysis by iterative coding of statements. RESULTS: The sample included 23 men and 17 women aged 13-60 years old, with risk factors for TB reported by 23/40 patients. Although patients were from different countries and cultural backgrounds, experiencing diverse health system contexts, five themes emerged as common across the sample. 1) Economic hardship from loss of income and medical/travel expenses. 2) Widespread stigma, delaying presentation and deeply affecting patients' emotional wellbeing. 3) TB and HIV co-infection was particularly challenging, but increased TB awareness and accelerated diagnosis. 4) Disruption to family life strained relationships and increased patients' feelings of isolation and loneliness. 5) The COVID-19 pandemic made it easier for TB patients to keep their condition private, but disrupted access to services. CONCLUSIONS: Despite disparate cultural, socio-economic, and systemic contexts across countries, TB patients experience common challenges. A robust examination of the needs of individual patients and their families is required to improve the patient experience, encourage adherence, and promote cure, given the limitations of current treatment.

Plastic in the Thames: a river runs through it.

Although contamination of the marine ecosystems by plastics is becoming recognised as a serious pollution problem, there are few studies that demonstrate the contribution made by freshwater catchments. Over a three month period from September to December 2012, at seven localities in the upper Thames estuary, 8490 submerged plastic items were intercepted in eel fyke nets anchored to the river bed. Whilst there were significant differences in the numbers of items at these locations, the majority were some type of plastic. Additionally in excess of 20% of the litter items were components of sanitary products. The most contaminated sites were in the vicinity of sewage treatment works. While floating litter is visible, this study also demonstrates that a large unseen volume of submerged plastic is flowing into the marine environment. It is therefore important that this sub-surface component is considered when assessing plastic pollution input into the sea.