Household context and psychosocial impact of childhood multidrug-resistant tuberculosis in KwaZulu-Natal, South Africa

Loveday, Marian; Sunkari, Babu; Master, Iqbal; Daftary, Amrita; Mehlomakulu, Vuyelwa; Hlangu, Sindisiwe; Marais, Ben J.

doi:10.5588/ijtld.17.0371

Cited by 16 publications

(30 citation statements)

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“…Previous studies reporting experiences of children and adolescents during DR-TB treatment included hospitalized patients, majority of whom were HIV co-infected [22,23]; while in our study, the participants were non-HIV and received DR-TB treatment on ambulatory basis. Though our study findings are in line with previous literature on paediatric DR-TB, our study contributes to the evidence around influence of families and communities in DR-TB treatment journey of children and adolescents.…”

Section: Discussionmentioning

confidence: 97%

“…Group counselling sessions and support group meetings could be organized to discuss marriage concerns. To tackle stigma in community against DR-TB in general, mass awareness campaigns could be organized which will also aid in limiting TB transmission [23].…”

Section: Plos Onementioning

confidence: 99%

“…Continuous dialogue and shared ownership during treatment follow up, especially in adolescents may help in improving care [26]. Family or peer support was identified as the cornerstone for treatment success in patients [23,29]. An 'empowered buddy' provided support to the patient during their entire journey of treatment.…”

Section: Plos Onementioning

confidence: 99%

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Challenging drug-resistant TB treatment journey for children, adolescents and their care-givers: A qualitative study

Das

Mathur²,

Ravi³

et al. 2021

PLoS ONE

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Background Childhood multidrug-resistant TB (MDR-TB) still affects around 25000 children every year across the globe. Though the treatment success rates for drug-resistant TB (DR-TB) in children are better than adults, children and adolescents face unique hurdles during DR-TB (MDR-TB, Pre-XDR TB and XDR-TB) treatment. This study aimed to understand the patients, guardians and healthcare providers’ perspectives about DR-TB treatment journey of patients and caregivers. Methods This is a qualitative study involving in depth-interviews of purposively selected adolescents (n = 6), patients guardians (for children and adolescents, n = 5) and health care providers (n = 8) of Médecins Sans Frontières (MSF) clinic, Mumbai, India. In-depth face to face interviews were conducted in English or Hindi language using interview guides during September-November 2019. The interviews were audio-recorded after consent. Thematic network analysis was used to summarize textual data. ATLAS.ti (version 7) was used for analysis. Result The age of adolescent patients ranged from 15–19 years and four were female. Five guardians (of three child and two adolescent patients) and eight healthcare providers (including clinicians- 2, DOT providers-2, counselors-2 and programme managers-2) were interviewed. The overarching theme of the analysis was: Challenging DR-TB treatment journey which consisted of four sub-themes: 1) physical-trauma, 2) emotional-trauma, 3) unavailable social-support and 4) non-adapted healthcare services. Difficulties in compounding of drugs were noted for children while adolescents shared experiences around disruption in social life due to disease and treatment. Most of the patients and caregivers experienced treatment fatigue and burnout during the DR-TB treatment. Participants during interviews gave recommendations to improve care. Discussion The TB programmes must consider the patient and family as one unit when designing the package of care for paediatric DR-TB. Child and adolescent friendly services (paediatric-formulations, age-specific counselling tools and regular interaction with patients and caregivers) will help minimizing burnout in patients and caregivers.

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Section: Discussionmentioning

confidence: 97%

Section: Plos Onementioning

confidence: 99%

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Challenging drug-resistant TB treatment journey for children, adolescents and their care-givers: A qualitative study

Das

Mathur²,

Ravi³

et al. 2021

PLoS ONE

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“…Definitions of 'acceptability' for anti-tuberculosis drugs or regimens may differ in different sociocultural contexts and should therefore be investigated more systematically in diverse settings. 29,30 Despite being given instructions on how to administer treatment, we observed that drug manipulation is common practice among caregivers who adapt and adopt different strategies to improve TB treatment administration to children. Further research is needed to confirm the pharmacokinetic implications of these real-life approaches to administration of anti-tuberculosis drugs (given with yoghurt or over a couple of hours).…”

Section: Discussionmentioning

confidence: 97%

Acceptability of a first-line anti-tuberculosis formulation for children: qualitative data from the SHINE trial

Wademan

Busakwe

Nicholson

et al. 2019

int j tuberc lung dis

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SETTING: We conducted a qualitative exploration into the palatability and acceptability of a novel fixed-dose combination (FDC) anti-tuberculosis drug. This study was nested in the SHINE (Shorter treatment for minimal TB in children) trial, which compares the safety and efficacy of treating non-severe drug-susceptible tuberculosis (TB) with a 6 vs. 4 months anti-tuberculosis regimen in children aged 0–16 years. Participants were recruited in Cape Town, South Africa.OBJECTIVE: To describe the palatability and acceptability of a FDC of rifampicin, isoniazid and pyrazinamide among South African children and their caregivers in the SHINE trial.METHODS: We conducted 20 clinic observations of treatment administration, during which we conducted 16 semi-structured interviews with children and their caregivers. Data were organised thematically to report on experiences with administering and ingesting the FDC.RESULTS: Children and caregivers' experiences varied from delight to disgust. In general, participants said that the FDC compared favourably to other formulations. Pragmatic challenges such as dissolving the FDC and the time required to administer the FDC impeded caregivers' ability to integrate treatment into their daily routines. Drug manipulation was common among caregivers to improve TB treatment administration.CONCLUSION: This novel FDC appears acceptable for children, albeit with practical challenges to administration. Scale-up of FDC use should include supplementary intervention components to support caregivers.

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“…However, as we did not capture household costs, we were unable to determine which model of care was most cost-effective to patients and society overall. Although the diagnosis and treatment of MDR-TB in South Africa is free, patients incur substantial costs accessing health services, with the poorest patients incurring the highest costs [ 32 , 33 ]. In some instances, when patients can continue with their household duties and return to work when they respond to treatment, community-based treatment will reduce household costs.…”

Section: Discussionmentioning

confidence: 99%

MDR-TB patients in KwaZulu-Natal, South Africa: Cost-effectiveness of 5 models of care

Loveday

Wallengren²,

Reddy

et al. 2018

PLoS ONE

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BackgroundSouth Africa has a high burden of MDR-TB, and to provide accessible treatment the government has introduced different models of care. We report the most cost-effective model after comparing cost per patient successfully treated across 5 models of care: centralized hospital, district hospitals (2), and community-based care through clinics or mobile injection teams.MethodsIn an observational study five cohorts were followed prospectively. The cost analysis adopted a provider perspective and economic cost per patient successfully treated was calculated based on country protocols and length of treatment per patient per model of care. Logistic regression was used to calculate propensity score weights, to compare pairs of treatment groups, whilst adjusting for baseline imbalances between groups. Propensity score weighted costs and treatment success rates were used in the ICER analysis. Sensitivity analysis focused on varying treatment success and length of hospitalization within each model.ResultsIn 1,038 MDR-TB patients 75% were HIV-infected and 56% were successfully treated. The cost per successfully treated patient was 3 to 4.5 times lower in the community-based models with no hospitalization. Overall, the Mobile model was the most cost-effective.ConclusionReducing the length of hospitalization and following community-based models of care improves the affordability of MDR-TB treatment without compromising its effectiveness.

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Household context and psychosocial impact of childhood multidrug-resistant tuberculosis in KwaZulu-Natal, South Africa

Abstract: The socio-economic impact of childhood MDR-TB reverberates beyond diseased children to their affected households. Enhanced social protection, psychosocial support and treatment literacy would create the foundations for family-centred care.

Cited by 16 publications

References 0 publications

Challenging drug-resistant TB treatment journey for children, adolescents and their care-givers: A qualitative study

Challenging drug-resistant TB treatment journey for children, adolescents and their care-givers: A qualitative study

Acceptability of a first-line anti-tuberculosis formulation for children: qualitative data from the SHINE trial

MDR-TB patients in KwaZulu-Natal, South Africa: Cost-effectiveness of 5 models of care

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