Utilization of multidrug-resistant tuberculosis treatment services in selected districts of Bangladesh: qualitative findings from an implementation research using a gender lens

Bangladesh has a high prevalence of MDR-TB with significant challenges associated with treatment adherence. Yet, given the severity, long treatment duration, and the country’s prevailing gender norms and expectations, little is known about the enabling or hindering factors that influence access to MDR-TB treatment services when viewed through a gender lens. Therefore, using an implementation research framework, the current research explored the contextual factors that influence utilization of MDR-TB treatment services, with particular attention to how gender, intersecting with other social factors, shapes patients’ experiences. This paper presents qualitative findings from a larger mixed-methods study in Dhaka, Chattogram, Sylhet, Khulna, Pabna, and Mymensingh. After a household survey of 478 MDR-TB patients, 32 patients and 17 caregivers participated in in-depth interviews. Facility observations were also conducted. We analyzed the findings using a framework-based thematic analysis approach and present emerging themes across the five domains of the Consolidated Framework for Implementation Research (Innovation, Outer Setting, Inner Setting, Individuals, Implementation Process). The findings show that gender shaped patients’ treatment experience. While limited household resources constrained both men and women, the burden fell disproportionately on women through their roles shaped by social norms and expectations and unequal decision-making power. These social factors, along with adverse side effects, poor hospital facilities, and the requirement to make an upfront payment before reimbursement, act as barriers to a positive treatment experience, more so for women. However, allyship between patients and support from providers, along with free treatment and financial incentives, was found to motivate all patients, regardless of gender, towards treatment adherence. Gender shapes the uptake of MDR-TB treatment services through social roles, relations, and expectations, producing unequal consequences, particularly for women. To prevent the transmission of the disease, support treatment completion, and ensure a more equitable experience, future interventions and policies should adopt gender-transformative approaches that address the underlying norms and relations shaping who can access and benefit from care. not applicable.