Psychosocial support groups for patients with multidrug-resistant tuberculosis: Five years of experience

Acha, J.; Sweetland, A.; Guerra, D.; Chalco, K.; Castillo, H.; Palacios, E.

doi:10.1080/17441690701191610

Cited by 85Tuberculosis Research and EpidemiologyMedication Adherence and ComplianceHIV/AIDS Research and Interventions

Psychosocial support groups for patients with multidrug-resistant tuberculosis: Five years of experience

Acha, J., Sweetland, A., Guerra, D., Chalco, K., Castillo, H., Palacios, E.·2007·Global Public Health

DOI 10.1080/17441690701191610

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Abstract

This detailed case history traces the first 5 years of a psychosocial support group intervention aimed to improve adherence to individualized drug regimens for multidrug-resistant tuberculosis (MDR-TB) in Peru. A total of eight groups were established in metropolitan Lima and two provinces of Peru led by teams of psychiatrists and nurses. The intervention consisted of bi-monthly support groups, recreational excursions, symbolic celebrations, and periodic family workshops. Notably, of the 285 patients who participated in this intervention, only 3.5% defaulted from treatment. Details include the description of services, patient data, major psychosocial difficulties faced by this population, key challenges, and implications. Psychosocial support is a crucial component of treatment for MDR-TB in order to ensure completion of complicated treatment regimens and enable psychosocial rehabilitation after treatment.

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Acha et al. described perceived adherence benefits associated with long-term peer-support participation.
“Acha et al. [34] described perceived adherence benefits associated with long-term peer-support participation.”
From Psychosocial Interventions for Improving Treatment Adherence in Tuberculosis Patients: A Scoping Review of Evidence-Based Approaches. (2026) · cites this paper as [34]
Long-term participation in facilitated patient support groups was associated with sustained engagement in care and low treatment-interruption rates, alongside perceived adherence benefits among participants.
“Long-term participation in facilitated patient support groups was associated with sustained engagement in care and low treatment-interruption rates, alongside perceived adherence benefits among participants [34].”
From Psychosocial Interventions for Improving Treatment Adherence in Tuberculosis Patients: A Scoping Review of Evidence-Based Approaches. (2026) · cites this paper as [34]

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Navigating DR-TB Treatment care: a qualitative exploration of barriers and facilitators to retention in care among people with history of early disengagement from drug-resistant tuberculosis treatment in Johannesburg, South Africa
Mphothulo, N., Hlangu, S., Furin, J. J., Moshabela, M., & Loveday, M. (2025) · BMC Health Services Research · doi:10.1186/s12913-025-12265-z · Cited by 14 · see citing works
“Some studies have reported that providing support through addressing socioeco - nomic and psychosocial challenges can enable adherence and successful treatment outcomes in patients at high risk of poor default [9, 10].”
Training social workers to enhance patient-centered care for drug-resistant TB-HIV in South Africa
Zelnick, J., Seepamore, B., Daftary, A., Amico, K. R., Bhengu, X., Friedland, G. H., Padayatchi, N., Naidoo, K., & O’Donnell, M. R. (2018) · Public Health Action · doi:10.5588/pha.17.0114 · Cited by 14 · see citing works
Turning threats into opportunities: how to implement and advance quality TB services for people with HIV during the COVID‐19 pandemic and beyond
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“Psychosocial support improves retention in care for people with DR-TB [45] and provides crucial rehabilitation after treatment completion [46].”
Background
Estratégias de controle e atenção à tuberculose multirresistente: uma revisão da literature
Ballestero, J. G. D. A., de Lima, M. C. R. A. D., Garcia, J. M., Gonzáles, R. I. C., Sicsú, A. N., Mitano, F., & Palha, P. F. (2018) · Revista Panamericana de Salud Pública · doi:10.26633/rpsp.2019.20 · Cited by 11 · see citing works
“Três estudos foram desenvolvidos na África do Sul (16-18), dois na Índia (19, 20), um no Peru (21) e um no Peru e outros países (Haiti, Paquistão, Nepal, Tajiquistão, Indonésia, Quênia e Botsuana) (22).”
BackgroundInfluential
“As a patient I do not belong to the clinic, I belong to the community”: co-developing multi-level, person-centred tuberculosis stigma interventions in Cape Town, South Africa
Hayward, S. E., Vanqa, N., Makanda, G., Tisile, P., Ngwatyu, L., Foster, I., Mcinziba, A., Biewer, A., Mbuyamba, R., Galloway, M., et al. (2024) · BMC Global and Public Health · doi:10.1186/s44263-024-00084-z · Cited by 10 · see citing works
Comprehensive Intervention for Anxiety and Depression among the Community Elderly with Tuberculosis
Li, X., Wang, B., Xu, Y., Chen, Y., Zhang, Y. W., Huang, J., Yang, J., Tan, D., Li, M., Zhang, D., et al. (2019) · Basic and Applied Social Psychology · doi:10.1080/01973533.2019.1600519 · Cited by 10 · see citing works
“Previous studies have shown that psychological intervention could improve the TB treatment compliance and outcome for patients (Demissie, Getahun, & Lindtjørn, 2003; Hailu et al., 2016; Janmeja, Das, Bhargava, & Chavan, 2005; Sweetland, 2007).”
Sequelae of multidrug-resistant tuberculosis: protocol for a systematic review and meta-analysis
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Suicidality in Tuberculosis Patients and their NonTuberculosis Family Contacts in Nigeria
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Magnitude of depression and associated factors among patients with tuberculosis in sub-Saharan Africa: A systematic review and meta-analysis.
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Qualitative systematic reviews to increase the volume and diversity of patient perspectives included in the development of core outcome sets. Tuberculosis: a pilot study
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Qualitative interviews with non-national tuberculosis patients in Cairo, Egypt: understanding the financial and social cost of treatment adherence
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“Support groups for TB patients have been successful in other countries (Acha et al. 2007, Rocha et al. 2011).”
Background
A study on tuberculosis disease disclosure patterns and its associated factors: Findings from a prospective observational study in Chennai
Nagarajan, K., Muniyandi, M., Sellappan, S., Karunanidhi, S., Senthilkumar, K., Palani, B., Jeyabal, L., & Rajendran, K. (2023) · PLoS ONE · doi:10.1371/journal.pone.0280812 · Cited by 6 · see citing works
“Patient support systems are nurtured by way of building patient support groups, community support groups and patient provider forums [35, 36].”
Background
‘Ghost’ stories: sociocultural factors influencing tuberculosis treatment adherence in Ghana
Salifu, Y., Eliason, C., & Mensah, G. B. (2016) · Primary Health Care · doi:10.7748/phc.2016.e1159 · Cited by 5 · see citing works
The Battle Continues: An Interpretative Phenomenological Analysis of the Experiences of Multidrug-Resistant Tuberculosis (MDR-TB) Patients
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“They feel frustrated and useless for not being able to work and fulfill other social roles during medication (Acha et al., 2007; Morris et al., 2013).”
Influential
Canadian tuberculosis health care workers’ perspectives on education and counselling for patients and family members who are born outside of Canada
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“…al., 2018; Clarke et al., 2021; Daftary et al., 2015; McEwen, 2005; Moodley et al., 2020), despite considerable evidence of the devastating social and emotional losses experienced by families a ﬀ ected by TB (Acha et al., 2007; Macintyre et al., 2017; Shedrawy et al., 2019; Tanimura et al., 2014).”
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“As a patient I do not belong to the clinic, I belong to the community.” Co-developing a multi-level, person-centred tuberculosis stigma intervention in Cape Town, South AfricaPreprint
Hayward, S. E., Vanqa, N., Makanda, G., Tisile, P., Ngwatyu, L., Foster, I., Mcinziba, A., Biewer, A., Mbuyamba, R., Galloway, M., et al. (2024) · Research Square · doi:10.21203/rs.3.rs-3921970/v1 · Cited by 3 · see citing works
“…– all in the pilot stage – typically targeted one or possibly two levels; for example, TB support groups or clubs (individual/interpersonal), 40–42 home visits (individual/interpersonal), 42,43 education for patients/caregivers (individual/interpersonal), 44 health worker training…”
Background
Approaches to deliver depression care and understanding barriers and facilitators to implementation in people with tuberculosis in LMICs: a systematic review
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Caracterización de pacientes con tuberculosis y tuberculosis resistente a múltiples medicamentos en instituciones de tercer nivel de Bogotá D.C.
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Successful outcomes for patients with drug-resistant tuberculosis despite civil unrest and COVID-19 in Haiti
Vilbrun, S. C., Souroutzidis, A., Walsh, K. F., Ellis, J., Guiteau, C., Delva, S., Joissaint, G., Joseph, P., Pape, J. W., & Koenig, S. P. (2023) · PLOS Global Public Health · doi:10.1371/journal.pgph.0002356 · Cited by 1 · see citing works
Patient-centred interventions for drug-resistant tuberculosis: A scoping review
Mphothulo, N., Loveday, M., & Myburgh, H. (2025) · South African Family Practice · doi:10.4102/safp.v67i1.6180 · Cited by 1 · see citing works
“Five studies focused on enhancing provider–patient relationships ( n = 5), 21,22,23,27 three studies ( n = 3), 16,20,22 emphasised the importance of adherence to treatment, one study ( n = 1) provided information on DR-TB and its treatment, and one study ( n = 1) reminded patients to collect their…”
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The global burden of mental disorder
Prince, M. J. (2011) · doi:10.1093/med/9780199565498.003.0037 · Cited by 1 · see citing works
Assessment of Depression among Pulmonary Tuberculosis Patients: A Cross-Sectional Study from Pakistan.
Malik, M., Nasir, R., & Hussain, A. (2018) · Journal of Nursing · doi:10.18686/jn.v7i2.121 · Cited by 1 · see citing works
“Other reasons reported were disturbances in life processes, long duration of treatment and illness [13, 14].”
Background
Improved completing-treatment support among tuberculosis support group members through the CERMAT (Smart Against TB Transmission) program
Nursasi, A. Y., Rohana, I. G. A. P. D., Rachmawati, U., & Mulyana, R. (2022) · Journal of Community Empowerment for Health · doi:10.22146/jcoemph.66457 · Cited by 1 · see citing works
ADVERSE DRUG REACTIONS AND RESULTANT HEALTH-RELATED QUALITY OF LIFE DURING MULTIDRUG-RESISTANT TUBERCULOSIS TREATMENT IN SOUTH AFRICA
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Lewandowski, R. E. (2011) · doi:10.7916/d84f1xqq
“A study in Peru found that group psychotherapy improved adherence to tuberculosis treatment though only 13.3% of the sample was depressed 11 (Acha et al., 2007).”
BackgroundInfluential
Developing the Instrumen for Assessing Psychosocial Needs of Clients with Pulmonary Tuberculosis Short running title : Psychosocial Needs of Clients with TB
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Atenção a Tuberculose Multirresistente no Brasil: aportes à organização das Redes de Atenção à Saúde e a Gestão da Clínica
Ballestero, J. G. D. A. (2018) · doi:10.11606/t.22.2018.tde-01122017-195352
Optimal Management of Drug-Resistant Tuberculosis and Human Immunodeficiency Virus: an Update
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Long term follow-up of multidrug resistant tuberculosis in a pubertal child
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Patient-Centered MDR-TB Care: What do MDR-TB Patients in Urban and Rural Peru Say?
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Drug-Resistant Tuberculosis and HIV
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Acesso ao diagnóstico e tratamento da tuberculose multirresistente: análise discursiva
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“Trata-se de um estudo qualitativo, descritivo, desenvolvido em dois locais, um ambulatório de referência (AR) e um hospital de referência (HR), ambos localizados no interior de São Paulo, a fim de se compreender os aspectos amplos que envolvem o acesso ao diagnóstico e tratamento da TBMR. Pontua-se, no que se refere à…”
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Salud mental como predictor de egreso en pacientes con tuberculosis atendidos en centros de alta incidencia. Lima, Perú. 2015-2017
Requena-Herrera, M. P., Bedoya-Ismodes, E. O., Vitorino, J. A., & Soto, A. (2019) · Revista chilena de infectología · doi:10.4067/s0716-10182019000600723
Psychological and psychiatric disorders in tuberculosis patients
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Cuidado à pessoa com tuberculose multirresistente no contexto de municípios: realidade e validação de ferramenta para a gestão do cuidado
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5. THỰC TRẠNG TRẦM CẢM THEO THANG ĐIỂM PHQ-9 Ở NGƯỜI BỆNH LAO KHÁNG THUỐC TẠI VIỆT NAM NĂM 2023
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Associations of Depression and Antidepressant Use with the Risk of Tuberculosis Sequelae: Insight from Genetic Analysis
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“For example, in a 5-year retrospective study of 285 patients with multidrug-resistant tuberculosis in Peru, the addition of psychosocial therapy to standard anti-tuberculosis treatment significantly improved treatment adherence, completion, and social rehabilitation [37].”

Psychosocial Support Improves Treatment Adherence Among MDR-TB Patients: Experience from East Kazakhstan
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Psychosocial problems in Multidrug Resistance Tuberculosis (Mdr-Tb) patients: a qualitative study
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Development of a Patient-Centred, Psychosocial Support Intervention for Multi-Drug-Resistant Tuberculosis (MDR-TB) Care in Nepal
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Optimal methods of psychological support in patientswith multidrug-resistant pulmonary tuberculosis and their effect on adherence to treatment
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Authors: Acha, J., Sweetland, A., Guerra, D., Chalco, K., Castillo, H., & Palacios, E.
Affiliations: Partners In Health (US)
Corresponding author: Sweetland, A.
ORCID: Sweetland, A.
Castillo, H.
Venue: Global Public Health
Publisher: Informa UK Limited
Published: 2007-10
Volume: 2
Issue: 4
Pages: 404-417
ISSN: 1744-1692 (ISSN-L)
1744-1706
DOI: 10.1080/17441690701191610
OpenAlex: W2164332614
Cited by: 85
References: 30
Citations by year: 2026: 2 · 2025: 3 · 2024: 3 · 2023: 7 · 2022: 9 · 2021: 4 · 2020: 9 · 2019: 10 · 2018: 14 · 2017: 6 · 2016: 4 · 2015: 3 · 2014: 2 · 2013: 3 · 2012: 2
FWCI: 0.42
Type: journal article
Language: en
Open access: closed
Locations: Global Public Health (publishedVersion)
PubMed (publishedVersion)
Funders: Bill and Melinda Gates Foundation
Topics: Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Keywords: multidrug-resistant tuberculosis, psychosocial support groups, medication adherence, treatment default, psychiatric nursing, family workshops, psychosocial rehabilitation, Peru, Lima
MeSH terms: Adolescent, Adult, Aged, Child, Female, Humans, Male, Middle Aged, Peru, Social Support, Focus Groups, Tuberculosis, Multidrug-Resistant, Drug Resistance, Multiple, Bacterial, Young Adult

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Psychosocial support groups for patients with multidrug-resistant tuberculosis: Five years of experience

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