Background: Tuberculosis (TB) treatment loss to follow up (LTFU) plays an important contributory role to the\nstaggering TB epidemic in South Africa. Reasons for treatment interruption are poorly understood. Treatment\ninterruption appears to be the culmination of poor health literacy of patients and inadequate health education\nprovided by clinicians. We explored clinician and patient perspectives of the gaps in TB messaging that influence\nTB treatment LTFU.\nMethods: We conducted semi-structured in-depth interviews between January and May 2018 with a sample of 15\nclinicians managing TB and 7 patients identified as LTFU in public clinics in the Free State Province, South Africa.\nThematic analysis using a mixed deductive/inductive thematic approach was used.\nResults: Limited occupational opportunities, fear of disclosure and stigmatization all contributed to treatment LTFU.\nPatients felt that the TB messaging received was inadequate. Many of the clinicians interviewed felt that improving\npatientâ??s TB knowledge would reinforce adherence to treatment and thus focused on sharing information on\ntreatment completion, side effects and infection control. However, the inability of clinicians to establish rapport\nwith patients or to identify social support challenged TB treatment adherence by patients. Clinicians perceived this\nas patients not following their instructions despite what they considered lengthy TB education. Having said this,\nclinicians concurred that their medical management of TB lacked the psycho-social dimension to treat a social\ndisease of this magnitude.\nConclusions: Limited occupational opportunities, fear of disclosure and stigmatization all contributed to treatment\nLTFU. Clinicians concurred that poor patient understanding of TB and that biomedical management lacking a\npsycho-social dimension further exacerbated the poor treatment outcome. TB remains a social disease, the\nsuccessful management of which hinges on patient-centred care.
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