Factors Affecting Treatment Adherence Among Persons With Multidrug-Resistant Tuberculosis (MDR-TB) in Western India: A Qualitative Exploration.

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) treatment involves prolonged regimens, multiple adverse effects, and significant psychosocial stressors, often leading to poor adherence. Limited qualitative research from western India has explored patients' lived experiences during MDR-TB treatment. OBJECTIVE: To explore factors influencing treatment adherence among persons with MDR-TB in western India and to identify potential strategies for improving retention in care. METHODS: A qualitative study was conducted in 2018 among 15 patients receiving treatment for MDR-TB at a district-level treatment center in Jodhpur, Rajasthan. Participants were purposively selected to capture variation in age, gender, and place of residence. Data were collected through in-depth, unstructured interviews conducted in the local language (Marwari), audio-recorded with consent, and transcribed verbatim into English. Thematic analysis was undertaken inductively by two independent researchers, followed by consensus coding. Data saturation was considered achieved when no new themes emerged. RESULTS: Eight key themes emerged: (1) inadequate knowledge and myths about MDR-TB, (2) long pathways to diagnosis and treatment initiation, (3) lack of confidence in treatment efficacy, (4) inability to work and financial hardship, (5) treatment-related side effects, (6) inadequate family and social support, (7) stigma and fear of discrimination, and (8) patient-identified strategies for improvement. Participants suggested shorter regimens, extended drug dispensing intervals, and timely financial support under government schemes as facilitators of adherence. CONCLUSIONS: Treatment adherence among MDR-TB patients in western India is shaped by biomedical, psychosocial, and structural factors. Patient-centered approaches, which address myths, ensure psychosocial and financial support, and introduce flexible, shorter regimens, are crucial for improving treatment outcomes. Strengthening the Direct Benefit Transfer scheme and community-based support programs could play a pivotal role in enhancing adherence and treatment success.