Bridging the gap in tuberculosis care: A mixed-methods analysis of patient safety challenges and solutions in India

Despite global advancements in tuberculosis (TB) management, significant patient safety gaps remain, particularly affecting vulnerable populations in resource-limited settings. Aligning with calls for solution-oriented research, this study addresses systemic safety challenges in TB management and suggests targeted interventions to improve equity and care quality gaps.

A mixed-methods study was conducted at ICMR-RMRIMS in Patna, India, involving TB patients (n = 100), healthcare professionals (n = 30), and caregivers (n = 30). Data from treatment charts, surveys, interviews, and focus groups were analyzed using descriptive statistics, regression models (quantitative), and thematic analysis (qualitative).

The results of the study revealed critical safety gaps with 43 % of patients had experienced diagnostic delays (p = 0.005), 32 % had adverse drug reactions (p = 0.028), and 15 % showed medication non-adherence (p = 0.002). Regression analysis identified illiteracy (β = 0.334, p < 0.001) and delayed diagnosis (β = 0.304, p < 0.001) emerging as key risk predictors, with mask usage (β = -0.173, p = 0.036) and hygiene education (β = -0.234, p = 0.013) as significant protective measures. A striking know-do-gap existed among providers with 93 % knowing WHO guidelines, but only 63 % consistently used PPE reflecting trade-off between safety protocols and real-world constraints. Qualitative findings revealed financial constraints (43 % delayed diagnosis) and GI ADRs as key adherence barriers, compounded by medication access issues (11 % unavailability). Healthcare providers reported 3.7 day isolation delays due to infrastructure limitations, advocating for community-based solutions like mobile clinics and family screening to strengthen safety.

This study identifies critical, modifiable gaps in TB patient safety, including diagnostic delays, medication risks, and PPE non-compliance. Findings emphasize the integration of health literacy, decentralized diagnostics, adverse event management, socioeconomic support for vulnerable populations, and specialized provider training to strengthen safety in high-burden settings.