Abstract
BackgroundLimited treatment options, long duration of treatment and associated toxicity adversely impact the physical and mental well-being of multidrug-resistant tuberculosis (MDR-TB) patients. Despite research advances in the microbiological and clinical aspects of MDR-TB, research on the psychosocial context of MDR-TB is limited and less understood.MethodologyWe searched the databases of PubMed, MEDLINE, Embase and Google Scholar to retrieve all published articles. The final manuscripts included in the review were those with a primary focus on psychosocial issues of MDR-TB patients. These were assessed and the information was thematically extracted on the study objective, methodology used, key findings, and their implications. Intervention studies were evaluated using components of the methodological and quality rating scale. Due to the limited number of studies and the multiple methodologies employed in the observational studies, we summarized these studies using a narrative approach, rather than conducting a formal meta-analysis. We used ‘thematic synthesis’ method for extracting qualitative evidences and systematically organised to broader descriptive themes.ResultsA total of 282 published articles were retrieved, of which 15 articles were chosen for full text review based on the inclusion criteria. Six were qualitative studies; one was a mixed methods study; and eight were quantitative studies. The included studies were divided into the following issues affecting MDR-TB patients: a) psychological issues b) social issues and economic issues c) psychosocial interventions. It was found that all studies have documented range of psychosocial and economic challenges experienced by MDR-TB patients. Depression, stigma, discrimination, side effects of the drugs causing psychological distress, and the financial constraints due to MDR-TB were some of the common issues reported in the studies. There were few intervention studies which addressed these psychosocial issues most of which were small pilot studies. There is dearth of large scale randomized psychosocial intervention studies that can be scaled up to strengthen management of MDR-TB patients which is crucial for the TB control programme.ConclusionThis review has captured the psychosocial and economic issues challenging MDR patients. However there is urgent need for feasible, innovative psychosocial and economic intervention studies that help to equip MDR-TB patients cope with their illness, improve treatment adherence, treatment outcomes and the overall quality of life of MDR-TB patients.
Highlights
The emergence of strains with multidrug-resistant tuberculosis (MDR-TB) has led to a resurgence of TB as a major public health menace worldwide
A total of 282 published articles were retrieved, of which 15 articles were chosen for full text review based on the inclusion criteria
It was found that all studies have documented range of psychosocial and economic challenges experienced by MDR-TB patients
Summary
The emergence of strains with MDR-TB has led to a resurgence of TB as a major public health menace worldwide. Most MDR-TB patients remain undetected and untreated [2,3], exposing their families and communities to the risk of acquiring MDR-TB strains transmitted through the air especially in high density communities and among people with HIV/AIDS [1,4]. This emergence of MDR-TB is attributed primarily to poor patient management and nonadherence to the prescribed regimen [5,6]. The proportion of MDR-TB patients who successfully complete treatment remains less than 50% These poor outcomes are primarily due to the long duration of treatment (often 24 months or longer) and drug toxicity [7], which result in poor treatment adherence. Despite research advances in the microbiological and clinical aspects of MDR-TB, research on the psychosocial context of MDR-TB is limited and less understood
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