A novel approach for eliciting adolescent MDR-TB treatment tolerability: qualitative data from South Africa

• Published in: The international journal of tuberculosis and lung disease Vol. 24; no. 1; pp. 43 - 47
• Main Authors: Zimri, K., Casper, R., Hoddinott, G., Schaaf, H. S., Garcia-Prats, A. J., Rose, P. C., Hesseling, A. C., Viljoen, L.
• Format: Journal Article
• Language: English
• Published: France International Union Against Tuberculosis and Lung Disease 01-01-2020; International Union against Tuberculosis and Lung Disease (IUATLD)
• Subjects: Adolescent; Adolescents; Antitubercular Agents - adverse effects; Assessments; Audiology; Body Mapping; Child; Children; Cohort Studies; Humans; Itching; Mapping; Multidrug resistance; Multidrug resistant organisms; Multidrug-Resistant Tuberculosis; Nausea; Paediatric; Pain; Pharmacokinetics; Pharmacovigilance; Pruritus; Qualitative analysis; Qualitative Research; Side effects; South Africa - epidemiology; Teenagers; Toxicity; Tuberculosis; Tuberculosis, Multidrug-Resistant - drug therapy; Vomiting; South Africa
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.19.0207

SETTING: Treatment tolerability among adolescents diagnosed with multidrug-resistant tuberculosis (MDR-TB) is underexplored. We present qualitative study data from adolescents participating in an observational cohort in the Western Cape, South Africa.OBJECTIVE: To
elicit adolescent experiences of MDR-TB diagnosis and treatment with qualitative body-mapping activities and discussions.DESIGN: Adolescents in an observational MDR-TB cohort received routine toxicity and audiology screenings from clinicians. We enrolled eight participants (age
10-16 years) to participate in additional body-mapping activities and in-depth interviews. A thematic deductive analysis was conducted. We present a comparison of the clinical assessments and qualitative discussions.RESULTS: Adolescent participants reported few adverse effects
on standard toxicity and audiology reports. Only nausea and vomiting were reported in >10% of cases, all of which were grade 1 (causing no/minimal interference) adverse effects (AEs). However, when comparing toxicity reports with qualitative body-mapping activities and interviews, we found
previously unreported AEs (neurosensory alteration, neuromuscular weakness, pain); underestimated severity of AEs (nausea, itching); and missed psychosocial symptoms (signs of depression).CONCLUSION: Adolescents receiving treatment for MDR-TB experienced treatment-related AEs that
were not reported during routine clinical assessments. Psychosocial experiences of adolescents are not taken into account. More research is needed to understand the experiences of this vulnerable group. We recommend that drug safety monitoring be adapted to include more creative and patient-driven
reporting mechanisms for vulnerable groups, including children