Abstract:

Background: Multidrug resistance is one of the emerging public health issue around the world as the treatment is challenging due to loss to follow up and side effects. Multiple factors are responsible for the adherence of treatment. Side effects of drugs, lengthy treatment duration, and complicated treatment procedures are major hindrances in treatment of MDR TB. Similarly, family and social support have prime role in maintaining the treatment adherence among the patients.

Objective: The objective of this study was to find out the role of family and social support in treatment adherence of MDR patients.

Methods and material: Focus Group Discussion and group discussion were conducted in 2 treatment centers NTC and GENETUP. The information collected through FGD and group discussion were translated, transcribed and then respective themes were constructed under which analysis was performed.

Results: Majority of the respondents had received family support for their treatment. Respondents reported that main reasons behind non-adherence of TB was due to side effects of the drugs. Almost 1/3^rd of the respondents felt discrimination from the society while many of them are not engaged in any income generation due to weakness and physical symptoms. The disease status has been disclosed to only close ones in most of the cases rather than the neighbors. Social stigma and discrimination are the reasons behind not disclosing their status.

Conclusion: This study shows that family are the one who are close to the patient and their support plays a crucial role for treatment adherence. Societal support is also necessary but the various stigmas associated with the disease have resulted to hide the disease in community.

Keywords: Adherence, Family and social support, MDR TB, Resistance, Nepal.

References:

[1].   Aryal, S., Badhu, A., Pandey, S., Bhandari, A., Khatiwoda, P., Khatiwada, P., & Giri, A. (2012). Stigma related to tuberculosis among patients attending DOTS clinics of Dharan Municipality.Kathmandu University Medical Journal, 10(37), 48–52.

https://doi.org/10.3126/kumj.v10i1.6914.

[2].   Bichha, R.P., Karki, K.B., Jha, K.K., Salhotra, V.S., & Weerakoon, A.P. (2018). Barriers to Directly Observed Treatment for Multi Drug Resistant Tuberculosis Patients in Nepal - Qualitative Study.SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS, 16(1), 6–18.  https://doi.org/10.3126/saarctb.v16i1.23239.

[3].   Gebreweld, F.H., Kifle, M.M., Gebremicheal, F.E., Simel, L.L., Gezae, M.M., Ghebreyesus, S.S., … Wahd, N.G. (2018). Factors influencing adherence to tuberculosis treatment in Asmara, Eritrea: a qualitative study. Journal of Health, Population and Nutrition. https://doi.org/10.1186/s41043-017-0132-y.

[4].   Global tuberculosis report. (2018). Global Health TB Report. In World Health Organization. https://doi.org/ISBN 978-92-4-156564-6.

[5].   Gube, A.A., Debalkie, M., Seid, K., Bisete, K., Mengesha, A., Zeynu, A., … Gebremeskel, F.(2018).Assessment of Anti-TB Drug Nonadherence and Associated Factors among TB Patients Attending TB Clinics in Arba Minch Governmental Health Institutions, Southern Ethiopia.Tuberculosis Research and Treatment, 2018, 1–7.

https://doi.org/10.1155/2018/3705812.

[6].   Paz-Soldán, V.A., Alban, R.E., Jones, C.D., & Oberhelman, R. A. (2013). The provision of and need for social support among adult and pediatric patients with tuberculosis in Lima, Peru: A qualitative study. BMC Health Services Research.

https://doi.org/10.1186/1472-6963-13-290.

[7].   Report, A. (2018). NTP-Annual-Report-2074-75-Up.75.

[8].   Ruru, Y., Matasik, M., Oktavian, A., Senyorita, R., Mirino, Y., Tarigan, L.H., Alisjahbana, B. (2018). Factors associated with non-adherence during tuberculosis treatment among patients treated with DOTS strategy in Jayapura, Papua Province, Indonesia.Global Health Action, 11(1), 1510592. https://doi.org/10.1080/16549716.2018.1510592.

[9].   Samal, J. (2017). Family Perspectives in the Care and Support of Tuberculosis Patients: An Indian Context.The Journal of Association of Chest Physicians, 5.

https://doi.org/10.4103/2320-8775.202899.

[10].  Sengupta, S., Pungrassami, P., Balthip, Q., Strauss, R., Kasetjaroen, Y., Chongsuvivatwong, V., & Van Rie, A. (2006). Social impact of tuberculosis in southern Thailand: Views from patients, care providers and the community. International Journal of Tuberculosis and Lung Disease.

[11].  Sermrittirong, S., Van Brakel, W.H., Kraipui, N., Traithip, S., & Bunders-Aelen, J.F.G. (2015). Comparing the perception of community members towards leprosy and tuberculosis stigmatization. Leprosy Review, 86(1), 54–61.

[12].  Truzyan, N., Crape, B., Harutyunyan, T., & Petrosyan, V. (2018). Family-Based Tuberculosis Counseling Supports Directly Observed Therapy in Armenia: A Pilot Project.Journal of Tuberculosis Research, 6(2), 113–124.

https://doi.org/10.4236/jtr.2018.62011.

[13].  Yin, J., Wang, X., Zhou, L., & Wei, X. (2018). The relationship between social support, treatment interruption and treatment outcome in patients with multidrug-resistant tuberculosis in China: a mixed-methods study. Tropical Medicine and International Health, 23(6), 668–677.

https://doi.org/10.1111/tmi.13066.

[14].  Franke, M.F., Appleton, S.C., Bayona, J., Arteaga, F., Palacios, E., Llaro, K., ...Mitnick, C.D. (2008). Risk factors and mortality associated with default from multidrug-resistant tuberculosis treatment. Clinical infectious diseases, 46(12), 1844-1851.

[15].  Khanal, S., Elsey, H., King, R., Baral, S.C., Bhatta, B.R., & Newell, J.N. (2017). Development of a patient-Centred, psychosocial support intervention for multi-drug-resistant tuberculosis (MDR-TB) Care in Nepal. PloS one, 12(1), e0167559.

[16].  Lewis, C.P., & Newell, J.N. (2009). Improving tuberculosis care in low income countries–a qualitative study of patients' understanding of patient support in Nepal. BMC public health, 9(1), 190.

[17].  Paz-Soldán, V.A., Alban, R.E., Jones, C.D., & Oberhelman, R.A. (2013). The provision of and need for social support among adult and pediatric patients with tuberculosis in Lima, Peru: a qualitative study. BMC health services research, 13(1), 290.