title: Psycho-Socio-Economic Issues Challenging Multidrug Resistant Tuberculosis Patients: A Systematic Review.
abstract: BACKGROUND
  Limited 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  This 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.
authors.affiliation: National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, India.
authors.forename: Beena Elizabeth
authors.initials: BE
authors.lastname: Thomas
authors.affiliation: National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, India.
authors.forename: Poonguzhali
authors.initials: P
authors.lastname: Shanmugam
authors.affiliation: National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, India.
authors.forename: Muniyandi
authors.initials: M
authors.lastname: Malaisamy
authors.affiliation: National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, India.
authors.forename: Senthanro
authors.initials: S
authors.lastname: Ovung
authors.affiliation: National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, India.
authors.forename: Chandra
authors.initials: C
authors.lastname: Suresh
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America.
authors.forename: Ramnath
authors.initials: R
authors.lastname: Subbaraman
authors.affiliation: Vector Control Research Centre, ICMR, Pondicherry, India.
authors.forename: Srividya
authors.initials: S
authors.lastname: Adinarayanan
authors.affiliation: National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, India.
authors.forename: Karikalan
authors.initials: K
authors.lastname: Nagarajan
mesh_terms: D000041:Absenteeism; D000328:Adult; D000437:Alcoholism / Q000453:epidemiology; D000995:Antitubercular Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D001007:Anxiety / Q000209:etiology; D017028:Caregivers; D015897:Comorbidity; D017281:Cost of Illness; D003863:Depression / Q000209:etiology; D004644:Emotions; D014943:Global Health; D015658:HIV Infections / Q000453:epidemiology; D006301:Health Services Needs and Demand; D006699:Home Care Services / Q000191:economics; D006801:Humans; D007398:Interpersonal Relations; D012929:Psychological Distance; D011584:Psychology; D011788:Quality of Life; D012934:Social Isolation; D012944:Social Support; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology / Q000523:psychology*; D014478:Unemployment
chemical_list: D000995:Antitubercular Agents