Table 3.

Representation of themes

Themes	Subthemes
	Pretreatment phase	Treatment phase
Challenges	The time from diagnosis to treatment is a big challenge in a patient’s life which breaks him in all possible ways, be it emotionally, physically or financially.
Physical challenges	Physical symptoms discomfit normal activities of daily life. Like household chores or even taking care of personal chores.	Adverse effects of drugs are experienced by many patients. These side-effects adversely impact the life of the patient. Multiple drugs/pill burden is also reported to be difficult to tolerate by the patients.
Health system challenges	Healthcare facilities are difficult to reach because of distance. The attitude of health facility personnel. No proper channel or awareness about the facility.	The facilities at DR-TB centres are not sufficient and the distance that one has to travel to reach the centre is about 120–240 km. The facilities like place and food in the hospital ward are not proper. The number of days to be admitted in a hospital for treatment initiation is also longer (15 days).
Economic challenges	Loss of income as no work due to poor physical health.	Until the time patient gets DBT money for treatment only, one has to pay the large amount out of his/her pocket for travelling, food and daily necessities.
Emotional and psychological challenges	Due to physical ill health, he/she is dependent on others for the daily necessities, so emotional state is devastated.	Once a patient gets information about his TB disease particularly DR status, the hope of living just vanishes as they consider it to be a fatal disease with no cure.
Social challenges	Lack of involvement in social gatherings due to poor health conditions.	Stigmatisation is not reported by the participants but they avoid social gatherings due to their poor health condition.

DBT, direct benefit transfer; DR-TB, drug-resistant tuberculosis.