Overcoming Barriers to Tuberculosis Care in the DRC

New qualitative research conducted by the CCP-led Breakthrough ACTION project sheds light on the challenges associated with TB care.
TB

The Democratic Republic of Congo (DRC), despite having one of the highest tuberculosis (TB) mortality rates globally, has developed a comprehensive TB care system supported by government and donors. Treatment is offered free of charge, and nearly 90 percent of individuals who begin treatment complete it successfully.

But here’s the catch: A large percentage of TB cases aren’t being discovered at all, due to significant barriers to seeking care for coughs and screening for TB. Inadequate screening leads to missed treatment opportunities, allowing untreated cases to fuel disease spread within communities.

Recent qualitative research conducted by the Johns Hopkins Center for Communication Programs-led Breakthrough ACTION project sheds light on the challenges associated with the continuum of TB care.

Findings suggest that many individuals dismiss the need for a health center visit when minor symptoms like coughs can be readily treated at home. The perception of high health care costs and the fear of testing positive for stigmatized conditions like TB and HIV, often associated and considered as death sentence, also create a significant barrier to seeking professional medical care.

This reluctance to seek testing and treatment not only endangers individuals but also hinders broader efforts to detect new cases and control of the spread of the disease, the researchers say.

Furthermore, the fear of missing work, social isolation, and dependence on others during a lengthy treatment period often prevents people from being screened for TB. Patients may be ostracized and struggle to meet basic needs, including proper food while undergoing the demanding six-to-nine-month medication regimen.

“The research question stemmed from asking why we have such a huge gap in case detection,” says Didier Mbayi Kangudie, CCP’s country director for the DRC. “Traditionally, there has been this idea that we just need to teach people more about TB symptoms and the need for testing, and they will do it.

“What this research did was help us zero in on what the obstacles were, be they structural, social, or behavioral, that are most likely to open up a new understanding of how to get more people into testing and treatment.”

Says CCP researcher Radha Rajan: “In the DRC, there are really good resources for TB treatment, but people just aren’t going for testing to be referred to treatment as they should. Through the research, we now know that people may need transportation to faraway testing centers, help from TB survivors who serve as patient advocates, or a greater understanding of how effective the current treatment is. This could make a real difference.”

There are other factors that increase risk for TB. Hazardous working conditions, such as those found in the mines in the south-eastern part of DRC, contribute to increased transmission among miners, compounded by smoking, heavy drinking and poor nutrition. Additionally, crowded living conditions increase risk among urban dwellers, where health workers’ safety concerns can limit access to care

“Tuberculosis is a curable disease,” Rajan says. “We need to talk about TB like other common diseases, like malaria, where care seeking is not stigmatized.”

Findings from this research have been incorporated into the National TB Program’s strategic communication plan and they have been shared widely among TB experts throughout DRC.

A key recommendation is to establish community support groups. These groups can provide essential assistance to TB patients throughout their treatment journey.

While the funding for Breakthrough ACTION in the DRC is ending, Kangudie and his colleagues hope the government and other partners will continue incorporating these insights into future programming.

“Treating TB requires rethinking how we educate the public,” Rajan says. “The DRC is proud of the TB treatment services they’re providing. But public perception hasn’t caught up with today’s reality. The big picture is that we want people to know about improved treatments and get people back on their feet.”

That’s the only way the national TB control program will achieve its vision of eliminating TB by 2035, Kangudie says.

 

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