Improving Treatment Adherence in Youths With Multidrug-Resistant Tuberculosis With Psychosocial Intervention

Abstract

Introduction: Multidrug-resistant tuberculosis (MDR-TB) deeply impacts the well-being of adolescents and young adults (AYA), resulting in poor treatment adherence. Identifying psychosocial challenges and preferred interventions is essential to enhance treatment adherence and outcomes in this unique group.

Methods: This was a mixed-method study where participants aged between 15 and 24 years, diagnosed with MDR-TB, were recruited for in-depth interviews and a semi-structured questionnaire.

Results: The individual-level psychosocial challenges included mental stress, suicidal ideation, reluctance to continue medication, perceived and experienced stigma, and socio-economic burdens. Health system-related challenges encompassed delayed diagnosis, drug stockouts, and negative experiences with Health Care Providers (HCPs). Among 75 participants, the median age was 20.5 years, with 57% (n = 41) females, 85% (n = 62) single, and a median treatment duration of 8 months at the interview. Seventy-two percent (n = 54) of the participants reported psychological issues such as irritation, loneliness, anxiety, sleep disorder, suicidal ideation, and stigma. Individual-level interventions were preferred by 61% (n = 46) of participants, including social media, deep breathing, and exercise training.

Conclusions: To enhance results in MDR-TB, it is crucial to develop and assess personalized psychosocial interventions with tailored adjustments to tackle the psychosocial obstacles encountered by adolescents and young adults with MDR-TB.

Keywords: MDR‐TB; adolescents and young adults; intervention; psychosocial challenges.

FIGURE 1

Challenges faced during the treatment. Psychological challenges include anger/irritation, stress, sleep problems and low feeling; Affected daily activities include disturbances in the sleep‐wake cycle and challenges in managing routine activities; Effects on work/studies include unable to concentrate on work, memory issues, lost self‐desire to study, scored low grades, school/college dropouts; Economic challenges include challenging to meet living and the travel cost. Health system‐related challenges include delay in diagnosis and delay in treatment initiation.

FIGURE 2

Psychosocial intervention preferences. Individual interventions include social media, deep breathing techniques, exercise training, Individual counseling, helpline support for health, counseling booklet, emotion‐focused strategies; Group interventions include peer group support, Through social activities, Health insurance schemes, Workplace oriented activites, stigma reduction intervention.