Understanding how lived experiences and knowledge of tuberculosis influence health-care access in rural KwaZulu-Natal, South Africa: a qualitative study

Background Tuberculosis remains a leading infectious cause of morbidity in South Africa. Access to TB care is adversely influenced by a lack of decentralized diagnostic services and poor community knowledge about TB. Objective This study sought to investigate how knowledge of TB, lived experience and visits by health care workers influence access to TB care in uMkhanyakude District, KwaZulu-Natal, South Africa. Methods This study was nested within a parent study which recruited adults starting TB treatment and used a household contact platform to compare infectiousness among people with different characteristics. For the nested study we recruited a subset of participants and conducted observations in the home using a rapid ethnographic assessment approach. We also conducted structured in-depth interviews with participants and undertook informal conversations with their family members. Data were analysed thematically and guided by the Health Belief Model. Results We interviewed 30 participants and 28 household members, aged 18 to 80 years. Most participants were unemployed and lived in cramped homes with poor ventilation. Many demonstrated limited knowledge of TB symptoms, which led to delays in seeking treatment. However, those with prior TB experience or who had received home visits from healthcare workers reported seeking care more promptly. Conclusion Knowledge of TB symptoms, household TB experience, and home visits by health care workers influenced prompt access to TB care. Continued efforts are needed to strengthen knowledge about TB and create improved awareness about how to access local TB services.