TB patient support systems in Kerala: A qualitative analysis.

INTRODUCTION: Tuberculosis (TB) is one of the leading causes of death due to infectious diseases in the world. Kerala a southern state in India aims to eliminate TB in the near future. In order to achieve its goal Kerala is providing various social support services to TB patients to ensure their smooth transition as they pass through the treatment cascade. Therefore, the objective of the current study was to qualitatively analyse the support systems provided for TB patients in Kerala and to assess the enablers and challenges faced during the provision of these services. METHODOLOGY: A qualitative study using grounded theory approach was carried out among TB survivors, current TB patients and healthcare workers from all 14 districts of Kerala along with district health officials. A total of 14 in depth interviews were conducted among healthcare workers from all the districts of Kerala. Three FGDs were conducted, out of which two were among TB survivors and another one among current TB patients. The data was collected till data saturation was reached. The audio recorded data was transcribed, translated, manually coded and emerging themes and sub themes were identified. Using data triangulation, conclusions were made. RESULTS: It was observed that different TB support services were being provided across all the 14 districts of Kerala. Each of these initiatives were found to be unique in their own way for bridging the gaps in the in the continuum of care provided for TB patients. The main domains identified were grouped as support services provided for getting diagnosis, services provided after diagnosis of TB, prevention of TB and support provided to the patients reaching private sector. Under each of these domains a wide range of TB support initiatives that facilitated early diagnosis, good adherence to treatment, minimising patient inconveniences, stigma reduction, prevention out of pocket expenditure and emotional support were identified. Majority of these supportive measures were found not to be uniform throughout. Those are locally customised initiatives, evolved at different time periods with common objective of patient support. Community ownership, proactive health care system and political commitment contributed to these patient support systems. CONCLUSION: These support services offered to TB patients were found to be very effective in paving the way towards the goal of TB elimination in Kerala.