Table 3 Themes and subthemes from patient interviews and patients’ views of their influence on MDR-TB outcomes. (Brackets indicate the number of patients highlighting a subtheme in their interview, bold text indicates alignment of opinion between patients and HCPs)

Personal Factors

− High standard patient knowledge, understanding of resistance and of the importance of adherence to the end of the treatment schedule (10)

− Education from a number of sources including the HCP, peers and internet (8)

− Perception of MDR-TB as a dangerous and contagious illness (11)

− Belief in pharmaceutical medications (9)

− Positive perception of the future and hope in a cure (10)

− Positive patient attitude and a strong desire to be cured (7)

− Psychological resilience (11)

− Poor quality or limited knowledge (10)

− Contradictory advice/education from peers/family/HCPs (10)

− Belief in natural medicines more than/as much as pharmaceutical medications (7)

− Disbelief/distrust of pharmaceutical medications (11)

− Myths and misinformation (10)

− Negative patient attitude (6)

− Change in patient identity, not feeling “normal” (9)

− Experience/fear of stigma or discrimination (11)

− Psychological impact of MDR-TB (12)

− Isolation (11)

− Other comorbidities (4)

External Factors

− Family support (emotional/psychological/nutritional/financial) (11)

− Family willing to make sacrifices to help patient (8)

− Education of family to empower them to help patient (9)

− Religion as a source of psychological support (6)

− Holistic care provided by HCP team (10)

− Individualised care, patient feeling involved in treatment planning (9)

− Pragmatic approach to providing high standard care in a resource poor setting (5)

− Socioeconomic impact of illness and treatment (14)

− Poor nutrition (10)

− Resource poor health system (7)

− Lack of political will to tackle MDR-TB/TB on a regional/country level (6)

− Impact of illness on family (socially/psychologically/financially) (12)

− Disorganised care (7)

− Difficulty accessing treatment (8)

Clinical Factors

− Feeling mentally and physically prepared for the treatment (9)

− Strategies to reduce nausea due to treatment (10)

− Diagnosis at late stage of disease (7)

− Side-effects of the treatment (14)

− Long duration of treatment (11)

HCP-patient Relationship (13)

− Good, open and trusting HCP-patient relationship (13)

− Patient feeling comfortable sharing worries and concerns with HCPs without fearing judgment (12)

− Patient feeling valued (11)

− Good communication with HCP (12)

− Patient fear/experience of stigmatisation/discrimination from HCPs (5)