. 2019 Aug 22;19:594. doi: 10.1186/s12913-019-4429-y

Table 4.

HCP themes and subthemes and their influence on MDR-TB outcomes. (Brackets indicate the number of HCPs highlighting a subtheme in their interview, bold text indicates alignment of opinion between HCPs and patients)

Theme	Facilitators to achieving optimal outcomes (frequency out of 11)	Barriers to achieving optimal outcomes (frequency out of 11)
Personal Factors	− High standard patient knowledge and understanding (10) − Appreciation of the importance of adherence until the end of the treatment schedule (8) − Knowledge of TB and MDR-TB prior to diagnosis (5) − Targeted education of at-risk groups (4) − Belief in the efficacy of pharmaceutical medications (8) - Positive patient attitude, self-responsibility and desire to be cured (9) − Psychological resilience (6) − Information seeking behaviour (8)	− Poor level of understanding of resistance and the importance of adherence (9) − Education in non-simple language and not confirming patient understanding (7) − Contradictory advice from family or peers (8) − Lack of belief in health services and/or trust in alternative medicines (9) − Patient experience of or fear of stigma, discrimination or isolation (9) − Change in patient identity (7) − Doubt or denial of diagnosis (6) − Psychological impact of MDR-TB (7)
External Factors	− Effective teamwork within the HCP team/health Centre (7) − Ingenuity and pragmatism in working in a resource poor setting (4) − High standard family support (emotional, psychological, financial and nutritional) (10) − Holistic approach to care (9) − Home visits (7) − Individualised/personalised patient treatment plan (10)	− Resource poor health system (9) − Lack of political will to improve TB care on a regional/national government level (4) − Difficulty accessing treatment due to the financial impact of transport (9) − Socioeconomic impact of having MDR-TB (10) − Patient prioritizing other responsibilities over health (7) − Poor nutrition (10) − Impact of illness on patients’ families (6)
Clinical Factors	− Observed treatment (7) − Strategies to reduce side-effects (8)	− Long duration of treatment schedule (8) − Side-effects of the treatment (11) − Disabling illness (9)
HCP factors	− A good, open and trusting HCP-patient relationship (11) − Good communication (10) − The patient feeling valued and comfortable sharing concerns and worries with the HCP (9) − Reducing transmission within the population (7) − Following safety protocols to prevent HCP transmission. (8)	− Poor communication (7) − Patient experiencing/fearing stigmatisation from HCPs (5)

Theme

Facilitators to achieving optimal outcomes (frequency out of 11)

Barriers to achieving optimal outcomes (frequency out of 11)

Personal Factors

− High standard patient knowledge and understanding (10)

− Appreciation of the importance of adherence until the end of the treatment schedule (8)

− Knowledge of TB and MDR-TB prior to diagnosis (5)

− Targeted education of at-risk groups (4)

− Belief in the efficacy of pharmaceutical medications (8)

- Positive patient attitude, self-responsibility

and desire to be cured (9)

− Psychological resilience (6)

− Information seeking behaviour (8)

− Poor level of understanding of resistance and the importance of adherence (9)

− Education in non-simple language and not confirming patient understanding (7)

− Contradictory advice from family or peers (8)

− Lack of belief in health services and/or trust in alternative medicines (9)

− Patient experience of or fear of stigma, discrimination or isolation (9)

− Change in patient identity (7)

− Doubt or denial of diagnosis (6)

− Psychological impact of MDR-TB (7)

External Factors

− Effective teamwork within the HCP team/health Centre (7)

− Ingenuity and pragmatism in working in a resource poor setting (4)

− High standard family support (emotional, psychological, financial and nutritional) (10)

− Holistic approach to care (9)

− Home visits (7)

− Individualised/personalised patient treatment plan (10)

− Resource poor health system (9)

− Lack of political will to improve TB care on a regional/national government level (4)

− Difficulty accessing treatment due to the financial impact of transport (9)

− Socioeconomic impact of having MDR-TB (10)

− Patient prioritizing other responsibilities over health (7)

− Poor nutrition (10)

− Impact of illness on patients’ families (6)

Clinical Factors

− Observed treatment (7)

− Strategies to reduce side-effects (8)

− Long duration of treatment schedule (8)

− Side-effects of the treatment (11)

− Disabling illness (9)

HCP factors

− A good, open and trusting HCP-patient relationship (11)

− Good communication (10)

− The patient feeling valued and comfortable sharing concerns and worries with the HCP (9)

− Reducing transmission within the population (7)

− Following safety protocols to prevent HCP transmission. (8)

− Poor communication (7)

− Patient experiencing/fearing stigmatisation from HCPs (5)