Psychosocial Support Improves Treatment Adherence Among MDR-TBPatients: Experience from East Kazakhstan

A novel patient-oriented treatment delivery program was introduced for multi-drug resistant tuberculosis (MDR-TB) patients at high risk of treatment default in East Kazakhstan region, The Republic of Kazakhstan. In parallel interventions were introduced to improve programmatic and clinical management for all MDR-TB patients. To assess the effects of the patient support program on patient default rates, we analyzed the characteristics of MDR-TB patients referred to the psychosocial support (PSS) program, treatment adherence before and during the intervention for patients referred to the patient support program. In 2010, the total numberf MDR-patients starting second-line drug MDR-TB treatment was 426. The PSS program supported 228 (53%) patients considered to be at high risk of treatment default. The program contributed to strengthening of management of all MDR-TB patients during the ambulatory, continuation phase of treatment. The proportion of drug doses taken under direct observation improved from 48% to 97%, while division of intake of second-line anti-TB drugs in 2-3 portions per day decreased from 20% in 2009 to 0%. Interruptions of anti-TB drugs for at least one day decreased from 18% to 4% among all MDR-TB patients. Among patients included in the PSS program, no treatment default was observed and only one patient missed doses of treatment.