Exploring the Socio-cultural Dynamics of Treatment Adherence amongst Females living with Pulmonary Tuberculosis in Karachi, Pakistan.

Objective: To explore socio-cultural and grassroots factors influencing treatment non-adherence amongst females living with Pulmonary Tuberculosis (TB).

Methodology: A qualitative Phenomenological design was adopted. Twelve in-depth interviews were conducted at a TB Clinic in Karachi (The Behbud Health Clinic) from February, 2020 to May, 2020 with participants including (i) females living with Pulmonary TB and (ii) healthcare providers engaged in TB service-provision. Interviews were semi-structured and conducted in-person. Data was analyzed inductively using thematic analysis.

Results: Three themes contributing to treatment non-adherence emerged, which are: i) the burden of home-making with sub-themes of a culture of matriarchy, traditional household norms, and intended non-disclosure of TB status; ii) the journey of pursing treatment with subthemes of challenges in accessing diagnostic services, barriers in treatment adherence/continuation, unique treatment-related misconceptions; and iii) TB myths with subthemes emphasizing local rumors and an inherent lack of trust in public healthcare services.

Conclusion: This study reveals important grassroots, socio-cultural and physical barriers to treatment adherence among women, including gender, social norms and treatment demands. Addressing these requires a holistic approach prioritizing community awareness with a focus on understanding day-to-day lived experiences of TB and building healthcare provider capacity to provide treatment services that are responsive and sensitive to these barriers.