Person-centred care for people with tuberculosis-associated comorbidities: a multi-country qualitative study.

INTRODUCTION: To contribute to the development of a people-centred global framework for collaborative action on tuberculosis (TB) and comorbidities, a rapid qualitative study on the perspectives of people with lived experience of TB and its associated comorbidities was undertaken. METHODS: From August to October 2021, TB survivors from high-burden countries, who encountered at least one comorbidity during TB treatment, were interviewed to explore their healthcare experiences and priorities. Thematic analysis drew on a healthcare acceptability model. RESULTS: Participants (n=24, 13 women) were treated for drug-susceptible (n=13) or drug-resistant (n=11) TB between 2015 and 2021. They faced diverse comorbidities (mental health and substance use disorders, diabetes, Hepatitis C, lupus and HIV); half of whom reported more than one comorbidity, and all faced socioeconomic hardships. TB diagnosis and treatment exacerbated participants' comorbidities and, in the absence of integrated support, precipitated mental health challenges. Four healthcare priorities for addressing TB-associated comorbidities were identified: (1) disclosure and early identification of comorbidities, (2) timely and affordable access to care for comorbidities, (3) tailored counselling and peer support and (4) coordinated and consolidated care for TB and comorbidities. CONCLUSION: The syndemic manifestation of comorbidities in people affected by TB calls for a people-centred approach to care that facilitates building of trust with multiple care providers, timely linkages to non-TB programmes, access to integrated diagnosis and treatment, allaying intersecting stigmas and self-shame, and care coordination approaches that correspond to people's needs and preferences. These healthcare priorities were included in the WHO's Framework for collaborative action on TB and comorbidities.