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The Institute for Global Health and Development

Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/9

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Author: search.filters.author.Kielmann, KarinaSubject: search.filters.subject.Qualitative

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    I cry every day': experiences of patients co-infected with HIV and multidrug-resistant tuberculosis
    (Wiley-Blackwell, 2013-09) Isaakidis, P.; Rangan, S.; Pradhan, A.; Ladomirska, J.; Reid, T.; Kielmann, Karina
    Objectives To understand patients' challenges in adhering to treatment for MDR-TB/HIV co-infection within the context of their life circumstances and access to care and support. Methods Qualitative study using in-depth interviews with 12 HIV/MDR-TB co-infected patients followed in a Mdecins Sans Frontires (MSF) clinic in Mumbai, India, five lay caregivers and ten health professionals. The data were thematically analysed along three dimensions of patients' experience of being and staying on treatment: physiological, psycho-social and structural. Results By the time patients and their families initiate treatment for co-infection, their financial and emotional resources were often depleted. Side effects of the drugs were reported to be severe and debilitating, and patients expressed the burden of care and stigma on the social and financial viability of the household. Family caregivers were crucial to maintaining the mental and physical health of patients, but reported high levels of fatigue and stress. Mdecins Sans Frontires providers recognised that the barriers to patient adherence were fundamentally social, rather than medical, yet were limited in their ability to support patients and their families. Conclusions The treatment of MDR-TB among HIV-infected patients on antiretroviral therapy is hugely demanding for patients, caregivers and families. Current treatment regimens and case-holding strategies are resource intensive and require high levels of support from family and lay caregivers to encourage patient adherence and retention in care.
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    Qualitative research to enhance the evaluation of results-based financing programmes: The promise and the reality
    (The World Bank, 2016-02) Cataldo, Fabian; Kielmann, Karina
    This Discussion Paper presents the approach, findings, and recommendations from a desk review of the qualitative research conducted within Results-Based Financing programmes (RBF) under the Health Results Innovations Trust Fund (HRITF). The review included 17 studies conducted in Benin, Burundi, Cameroon, DRC, Ethiopia, Haiti, Kenya, Kyrgyzstan, Nigeria, Rwanda, Tajikistan, Tanzania, Zambia, and Zimbabwe. The studies reveal a body of high quality work that is consistent with the conceptual framework of RBF schemes, supported by political will, resources, and research capacity. Strengthening the added value of qualitative inquiry in on-going and future qualitative studies may be enabled by small shifts in thinking and practice, in line with a qualitative research paradigm. First, in order to better ground research in an existing country and system specific context, some interrogation of constructs and posited relationships in the existing conceptual framework for intervention/evaluation may be required. Second, to enable more in-depth and richer data that documents working practices and relations under RBF schemes, training of local researchers should place stronger emphasis on entry to the field, gaining trust, building rapport, and sustaining a dialogue with key informants. Third, smaller, more intensive and focused studies targeting fewer sites and smaller samples - but addressing a wider range of methods and informants within the health system - are likely to yield richer data that can support the understanding of how health workers and managers are responding to schemes, and what impact schemes have on service volumes and outputs.