title: Development of a Patient-Centred, Psychosocial Support Intervention for Multi-Drug-Resistant Tuberculosis (MDR-TB) Care in Nepal.
abstract: Multi-drug-resistant tuberculosis (MDR-TB) poses a major threat to public health worldwide, particularly in low-income countries. The current long (20 month) and arduous treatment regime uses powerful drugs with side-effects that include mental ill-health. It has a high loss-to-follow-up (25%) and higher case fatality and lower cure-rates than those with drug sensitive tuberculosis (TB). While some national TB programmes provide small financial allowances to patients, other aspects of psychosocial ill-health, including iatrogenic ones, are not routinely assessed or addressed. We aimed to develop an intervention to improve psycho-social well-being for MDR-TB patients in Nepal. To do this we conducted qualitative work with MDR-TB patients, health professionals and the National TB programme (NTP) in Nepal. We conducted semi-structured interviews (SSIs) with 15 patients (10 men and 5 women, aged 21 to 68), four family members and three frontline health workers. In addition, three focus groups were held with MDR-TB patients and three with their family members. We conducted a series of meetings and workshops with key stakeholders to design the intervention, working closely with the NTP to enable government ownership. Our findings highlight the negative impacts of MDR-TB treatment on mental health, with greater impacts felt among those with limited social and financial support, predominantly married women. Michie et al's (2011) framework for behaviour change proved helpful in identifying corresponding practice- and policy-level changes. The findings from this study emphasise the need for tailored psycho-social support. Recent work on simple psychological support packages for the general population can usefully be adapted for use with people with MDR-TB.
authors.affiliation: Health Research and Social Development Forum (HERD) Nepal, Thapathali, Kathmandu, Nepal.
authors.forename: Sudeepa
authors.initials: S
authors.lastname: Khanal
authors.affiliation: Nuffield Centre for International Health and Development (NCIHD), University of Leeds, Charles Thackrah Building, Leeds, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Elsey
authors.affiliation: Nuffield Centre for International Health and Development (NCIHD), University of Leeds, Charles Thackrah Building, Leeds, United Kingdom.
authors.forename: Rebecca
authors.identifier: 0000-0003-3035-9594
authors.initials: R
authors.lastname: King
authors.affiliation: Health Research and Social Development Forum (HERD) Nepal, Thapathali, Kathmandu, Nepal.
authors.forename: Sushil C
authors.initials: SC
authors.lastname: Baral
authors.affiliation: Health Research and Social Development Forum (HERD) Nepal, Thapathali, Kathmandu, Nepal.
authors.forename: Bharat Raj
authors.initials: BR
authors.lastname: Bhatta
authors.affiliation: Nuffield Centre for International Health and Development (NCIHD), University of Leeds, Charles Thackrah Building, Leeds, United Kingdom.
authors.forename: James N
authors.initials: JN
authors.lastname: Newell
mesh_terms: D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D009390:Nepal; D010353:Patient Education as Topic; D018802:Patient-Centered Care / Q000379:methods*; D000072858:Psychosocial Support Systems; D011795:Surveys and Questionnaires; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000523:psychology*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000523:psychology*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents