We telephonically contacted individuals from 15 households to participate in the in-depth interviews. Among these, individuals from 11 (73.3%) households agreed to participate and 4 (26.7%) households did not want to participate in the interviews. There was a mean of 2 contacts per household, similar to the mean household size of the area population. We enrolled 24 HHCs for qualitative work. There were 16 (66.7%) females: median age in males 34 years, and females 36 years. There were 4 (16.7%) self-reported HIV positive HHCs. No other demographic information was collected. We derived two major themes from the analysis; (i) Positive attitude of HHCs towards TB services provided at home and (ii) HHCs relationship to and acceptance of PLTB.
Main theme 1: Positive attitude of household contacts towards TB services provided at home
All HHCs appreciated the home visits and did not have a problem with research staff visiting them. Participants were not concerned about others in the community being aware of the home visits through use of a branded vehicle by the research team. Participants preferred home visits because they had negative experiences at the clinic such as delayed waiting times and long queues. TB screening services offered at home was also beneficial to children as they were less likely to go to the clinic. The quotations from three participants below describes their satisfaction with the home visit, especially related to screening their children for TB.
“I really liked the job they did for us; they made things easier for us because had they not come here I wouldn’t have {had} my children tested for TB, I would still be sitting here at home. I appreciate that they came here to test the children because I was concerned about their wellbeing. I am really happy about that because even my mother was tested and she hardly goes to the clinic to get tested. I am really happy for what they did for us…I was happy that they came to test the children for TB.” (ID 20)
“We just wanted those people to teach us new things, we did not have a problem at all.” (ID 21)
“All in all, it was good… An effort was made to get closer to us so that we can get tested; I think it was something good.” (ID 22)
Participants did not feel inconvenienced by the home visits and said that the research staff could visit them any time.
“No I’ve no problem, you can come day, night, at anytime.” (ID 1)
“Any day of the week because I am unemployed. Any time is okay with me.” (ID 17)
However, participants suggested that the research staff could expand their services by screening for other illnesses such as diabetes and high blood pressure. They also felt that the broader community should be reached as they could benefit from TB screening at their homes, since it is a helpful service.
“It is very important. You should encourage people to test, if a person is not feeling well they should test for TB, diabetes, high {}{blood} and all other diseases.” (ID 24)
“I don’t know, if you were to make a notice or maybe something like, I don’t know, have you ever seen those Coca Cola people on a lorry speaking on speakers?” (ID 4)
Main theme 2: Household contacts relationship to and acceptance of PLTB
There was a sense of responsibility from the HHCs towards accepting the diagnosis of their PLTB. However, it seemed that this feeling of taking care of their family member who was diagnosed with TB, was more out of a sense of obligation. Quotations from two participants describe their feelings towards their family member:
“So I’ve got a son with a TB…For now he’s okay and let me say that I’m dealing with that because I {} {have} no choice.” (ID 1)
“But the problem will be that I have a partner and I have asked him to accommodate the patient and there is no way I can abandon the sick patient.” (ID 3)
Subtheme: Knowledge gained from the home visits that influenced acceptance of PLTB
Although most HHCs described accurate knowledge of TB symptoms because of their experiences living with PLTB, they were still uncertain of how to take care of them. Participants felt that the information on TB disease and treatment provided during the home visits helped them to accept the TB status of the PLTB. Quotations from four participants below describe how the home visits empowered them to take care of the PLTB:
“The way you talk to me{} about that encourage{s} me…I like {it} because you give me hope to…to… to carry on…Because that’s the big help for me, for now I’ve got that courage because since the people come there I’ve got that{} courage because I know I’m not alone this time. There are people who{}{are} going to help me…You see that the things that make {} {you} say ‘okay I feel very happy because I got that courage now’, you are there, coming there to help me. I got that courage, okay there is somebody who {is} thinking about me, thinking about my situation.” (ID 1)
“Actually I thought that he was dying because he lost weight, too much weight yah so it {} hurt not knowing what is killing him and all that. But when I found out that it has treatment and it has a cure that gave me hope.” (ID 2)
“By coming here to talk to us and also they helped that person who had TB to accept his condition and then he helped us to understand where we all stand.” (ID 17)
“Okay, they explained to us that we must keep his room clean and give him appropriate food. I had always thought that when a person has TB you cannot share things such as plates with them, but after he was given the treatment we were told that we could share plates with him because they explained to us that TB is a bacterium on air.” (ID 22)