Understanding the relationship between adolescents with tuberculosis and health services: an indepth qualitative study from Cape Town

TL;DR

This study explores the challenges adolescents in Cape Town face when interacting with tuberculosis health services, highlighting the need for more adolescent-focused care.

Contribution

The study provides new insights into how adolescents experience TB health services and the barriers they face in diagnosis and treatment.

Findings

Adolescents faced difficulties and delays in obtaining accurate TB diagnoses despite seeking care from multiple providers.

Treatment regimens and adherence support processes were reported as significant challenges for adolescents.

Most adolescents felt well treated by health workers, indicating positive interactions despite systemic challenges.

Abstract

Adolescents’ experiences (10–19 years-old) with tuberculosis (TB) remain poorly understood. Descriptions of adolescent TB experiences, particularly how they interact with the health system, are scarce. We aimed to understand adolescents’ experiences of TB health services in the Western Cape, South Africa. We focused on how TB services were aided or hindered through interactions with healthcare providers and health system processes.

Teen TB, an observational study in Cape Town, enrolled 50 newly diagnosed adolescents with multidrug-resistant and drug-susceptible TB. A subset of 20 was selected for serial qualitative data collection, with 19 completing all tasks between December 2020 and September 2021. 52 interviews were conducted and thematically analysed using a case descriptive process for experiences across the TB care cascade.

Adolescents criticised the difficulties and delays they encountered in obtaining an accurate TB diagnosis. Initial misdiagnoses and delayed TB diagnoses were reported, despite seeking help from multiple healthcare providers at different facilities. Adolescents questioned whether the financial, social and emotional costs of TB care outweighed the costs of delaying treatment initiation and adherence. Adolescents reported that the treatment regimen, adherence support processes and interactions with the health system posed significant challenges to maintaining adherence. Encouragingly, however, most adolescents reported being well treated and cared for by health workers.

Our study shows that adolescents experience challenges throughout their TB treatment journeys. More adolescent-focused research is needed to tailor treatment and healthcare processes to their needs.