Social networks and social support for tuberculosis control in Kampala, Uganda.

摘要

This research examined how tuberculosis (TB) patients' social network and social support systems influence treatment seeking in Kampala, Uganda under two modified World Health Organization (WHO) approved Community Based - Directly Observed Therapy-Short Course treatment strategies (CB-DOTS). The specific objectives were to: (1) Describe social networks and social support systems of TB patients seeking treatment in Kampala over the course of treatment; (2) Identify factors influencing TB patients' choice of DOT strategy and compare social network characteristics between TB patients by DOT strategies; (3) Evaluate treatment outcomes among TB patients in relation to patients' social network characteristics and DOT strategy.;Most participants (79.3%, 69/87) self-selected home-based DOTS. Choice of DOT strategy is influenced by the composition of network members critical in the treatment seeking process at the time of initiating TB medication, partly explaining why home-based DOT was more popularly selected. Patients' networks are mainly kin-based, with an average of 3 persons involved in their treatment seeking process.;Whereas TB patients' social networks and social support systems play a critical role in enhancing care seeking at all times, there are variations in the nature of this role as treatment progresses. There is a decrease in network size between baseline and month-8 reaching an average of 2 persons (Mean=2.7, SD=1.6) at month-8. There is also less reception of concrete support between month-2 and month-5. The timing of these shifts suggests a potential disruption in the care seeking process between month-2 and month-5.;Self-selection of the DOT supporter from the patients' social networks enhances treatment support and perceived quality of care. Patients perceive the extra duties of the treatment supporter beyond DOT to be very crucial during the treatment process. Both CB-DOTS strategies achieved similar, but, higher success rates than the WHO target.;The DOTS strategy unfolds as a fluid process with important implications for the selection or designation of a DOT supporter. An anthropological implication of this study is that the nature and substance of social networks and support exchange during the treatment process shifts over time with important ramifications for ensuring appropriate care during long-term treatment.