{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T07:39:09Z","timestamp":1785310749401,"version":"3.55.0"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2020,12,21]],"date-time":"2020-12-21T00:00:00Z","timestamp":1608508800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>There are few data on the on the care experiences of pregnant women with rifampicin-resistant TB.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To describe the treatment journeys of pregnant women with RR-TB\u2014including how their care experiences shape their identities\u2014and identify areas in which tailored interventions are needed.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>In this qualitative study in-depth interviews were conducted among a convenience sample from a population of pregnant women receiving treatment for RR-TB. This paper follows COREQ guidelines. A thematic network analysis using an inductive approach was performed to analyze the interview transcripts and notes. The analysis was iterative and a coding system developed which focused on the care experiences of the women and how these experiences affected their perceptions of themselves, their children, and the health care system in which treatment was received.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>Seventeen women were interviewed. The women described multiple challenges in their treatment journeys which required them to demonstrate sustained resilience (i.e. to \u201cbe brave\u201d). Care experiences required them to negotiate seemingly contradictory identities as both new mothers\u2014\u201cgivers of life\u201d\u2014and RR-TB patients facing a complicated and potentially deadly disease. In terms of their \u201cpregnancy identity\u201d and \u201cRR-TB patient identity\u201d that emerged as part of their care experiences, four key themes were identified that appeared to have elements that were contradictory to one another (contradictory areas). These included: 1) the experience of physical symptoms or changes; 2) the experience of the \u201cmothering\u201d and \u201cpatient\u201d roles; 3) the experience of the care they received for their pregnancy and their RR-TB; and 4) the experience of community engagement. There were also three areas that overlapped with both roles and during which identity was negotiated\/reinforced and they included: 1) faith; 2) socioeconomic issues; and 3) long-term concerns over the child\u2019s health. At times, the health care system exacerbated these challenges as the women were not given the support they needed by health care providers who were ill-informed or angry and treated the women in a discriminatory fashion. Left to negotiate this confusing time period, the women turned to faith, their own mothers, and the fathers of their unborn children.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The care experiences of the women who participated in this study highlight several gaps in the current health care system that must be better addressed in both TB and perinatal services in order to improve the therapeutic journeys for pregnant women with RR-TB and their children. Suggestions for optimizing care include the provision of integrated services, including specialized counseling as well as training for health care providers; engagement of peer support networks; provision of socioeconomic support; long-term medical care\/follow-up for children born to women who were treated for RR-TB; and inclusion of faith-based services in the provision of care.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0242604","type":"journal-article","created":{"date-parts":[[2020,12,21]],"date-time":"2020-12-21T18:33:27Z","timestamp":1608575607000},"page":"e0242604","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["\u201cTake the treatment and be brave\u201d: Care experiences of pregnant women with rifampicin-resistant tuberculosis"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9205-9314","authenticated-orcid":true,"given":"Marian","family":"Loveday","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sindisiwe","family":"Hlangu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Furin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,12,21]]},"reference":[{"issue":"8","key":"pone.0242604.ref001","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1016\/j.jogc.2018.04.041","article-title":"Tuberculosis in pregnancy: a treacherous yet neglected issue","volume":"40","author":"G Sulis","year":"2018","journal-title":"Journal of Obstetrics and Gynaecology, Canada (JCOG)"},{"key":"pone.0242604.ref002","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/S0366-0869(46)80029-7","article-title":"Pulmonary tuberculosis and pregnancy","volume":"40","author":"R Cohen","year":"1946","journal-title":"British Journal of Tuberculosis and Diseases of the Chest"},{"issue":"5","key":"pone.0242604.ref003","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1111\/1471-0528.14408","article-title":"Maternal and perinatal mortality and morbidity associated with tuberculosis during pregnancy and the postpartum period: asystematic review and meta-analysis","volume":"124","author":"S Sobhy","year":"2017","journal-title":"BJOG"},{"issue":"6","key":"pone.0242604.ref004","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1093\/cid\/cix851","article-title":"Poor Obstetric and Infant Outcomes in Human Immunodeficiency Virus-Infected Pregnant Women With Tuberculosis in South Africa: The Tshepiso Study","volume":"66","author":"N Salazar-Austin","year":"2018","journal-title":"Clin Infect Dis"},{"issue":"4","key":"pone.0242604.ref005","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1586\/14787210.2.4.589","article-title":"Tuberculosis in pregnancy: current recommendations for screening and treatment in the USA","volume":"2","author":"KG Bergeron","year":"2004","journal-title":"Expert Review of Anti-infective Therapy"},{"issue":"7","key":"pone.0242604.ref006","doi-asserted-by":"crossref","first-page":"760","DOI":"10.5588\/ijtld.17.0448","article-title":"Burden of tuberculosis in HIV-positive pregnant women in Cape Town, South Africa","volume":"22","author":"J Odayar","year":"2018","journal-title":"Int J Tuberc Lung Dis"},{"key":"pone.0242604.ref007","article-title":"HIV-TB Coinfection among 57 Million Pregnant Women, Obstetric Complications, Alcohol Use, Drug Abuse, and Depression","author":"D Fernandez","year":"2018","journal-title":"Journal of Pregnancy"},{"issue":"12","key":"pone.0242604.ref008","doi-asserted-by":"crossref","first-page":"e675","DOI":"10.1016\/S2214-109X(14)70338-9","article-title":"The neglected global burden of tuberculosis in pregnancy","volume":"2","author":"A Zumla","year":"2014","journal-title":"The Lancet Global Health"},{"issue":"6","key":"pone.0242604.ref009","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1002\/cpt.1221","article-title":"State-of-the-Art Review of HIV-TB Coinfection in Special Populations","volume":"104","author":"ED Weld","year":"2018","journal-title":"Clinical pharmacology and therapeutics"},{"issue":"4","key":"pone.0242604.ref010","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/S0146-0005(97)80076-6","article-title":"Tuberculosis in pregnancy","volume":"21","author":"GD Anderson","year":"1997","journal-title":"Seminars in perinatology"},{"key":"pone.0242604.ref011","unstructured":"World Health Organization. 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