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)

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)