Psycho-Socio-Economic Issues Challenging Multidrug Resistant Tuberculosis Patients: A Systematic Review

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.

Addressing the tuberculosis–depression syndemic to end the tuberculosis epidemic

“…66 In settings with high levels of anti-tuberculosis drug resistance and limited access to drug susceptibility testing and treatment, prolonged infectiousness while receiving ineffective treatments can lead to clustering of cases within households or institutional settings, often resulting in catastrophic loss of life and financial burden. 64 Shame, blame, and discrimination are amplified in such situations, as well as compounded trauma if multiple individuals in the same family or household fail treatment and/or die before accessing adequate treatment.…”

Individualizing management of extensively drug-resistant tuberculosis: diagnostics, treatment, and biomarkers

“…The latter has been challenged [105]. The lengthy treatment with often severe toxicities call for social and psychological support for this often vulnerable patient group [106]. Providing patient-centered care, i.e.…”

Psychiatric disorders in patients with multidrug resistant tuberculosis (MDR-TB) in Sardjito Hospital, Yogyakarta, Indonesia

“…The impacts of stigma include social seclusion or rejection from family members, friends, neighbors, and/or health providers, internalized shame, financial instability, discrimination and its repercussion. 13 Lower level of education is associated with poor and ineffective coping styles. This results in higher prevalence of psychiatric problems.…”