The relationship between social support, treatment interruption and treatment outcome in patients with multidrug-resistant tuberculosis in China: A mixed-methods study
Open accessAbstract
OBJECTIVE: Multidrug-resistant tuberculosis (MDR-TB) has been a major threat for successful TB control. We examined the relationship between social support and treatment outcomes in MDR-TB patients and evaluated barriers to social support. METHODS: Retrospective cohort study with MDR-TB patients enrolled in the Global Fund programme between 1 January 2009 and 30 June 2014 in Zhejiang, China. We reviewed all MDR-TB patients' diagnoses and treatment outcomes. In-depth interviews were conducted with 10 community health workers and 10 patients. Pathway analysis was employed to examine the association between social support and treatment outcomes, and the mediating effect of medication adherence on their relationship. RESULTS: Of 218 participants, 144 (66%) were successfully treated and 59 (27%) had poor treatment adherence. Directly observed therapy (DOT) had an indirect positive effect on treatment success, mediating through medication adherence (β = 0.541, P = 0.008; β = 0.538, P < 0.001). Financial support had both a direct (β = 0.769, P < 0.001) and an indirect positive effect on treatment success, which was mediated by a self-reported social support scale (β = 0.541, P = 0.008; β = 0.538, P < 0.001). The interviews indicated poor performance of DOT. Patients often suffered from substantial stigma, but were not provided with psychological support. CONCLUSION: DOT and financial support were effective strategies for improving successful treatment outcomes in MDR-TB patients, but they were delivered not considering patients' perspectives. There is an urgent need for consistent and specific psychological support for MDR-TB patients in their communities.
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Qualitative findings from Yin et al. highlight a gap that can emerge between intervention design and real-world implementation fidelity.
“At the same time, qualitative findings from Yin et al. [33] highlight the gap that can emerge between intervention design and real-world implementation fidelity.”
From Psychosocial Interventions for Improving Treatment Adherence in Tuberculosis Patients: A Scoping Review of Evidence-Based Approaches. (2026) · cites this paper as [33]
In Yin et al., perceived social support appeared to mediate part of the relationship between financial assistance and treatment success.
“In Yin et al. [33], financial and social support were associated with improved treatment outcomes, and perceived social support appeared to mediate part of the relationship between financial assistance and treatment success.”
From Psychosocial Interventions for Improving Treatment Adherence in Tuberculosis Patients: A Scoping Review of Evidence-Based Approaches. (2026) · cites this paper as [33]
In Yin et al., family-member treatment observers were often insufficiently trained and monitored only a limited proportion of doses.
“In that study, family-member treatment observers were often insufficiently trained and monitored only a limited proportion of doses.”
From Psychosocial Interventions for Improving Treatment Adherence in Tuberculosis Patients: A Scoping Review of Evidence-Based Approaches. (2026) · cites this paper as [33]
In Yin et al., financial and social support were associated with improved treatment outcomes.
“In Yin et al. [33], financial and social support were associated with improved treatment outcomes, and perceived social support appeared to mediate part of the relationship between financial assistance and treatment success.”
From Psychosocial Interventions for Improving Treatment Adherence in Tuberculosis Patients: A Scoping Review of Evidence-Based Approaches. (2026) · cites this paper as [33]
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- Authors
- Yin, J., Wang, X., Zhou, L., & Wei, X.
- Affiliations
- Shandong University (CN)
- Zhejiang Center for Disease Control and Prevention (CN)
- University of Toronto (CA)
- Corresponding author
- Wei, Xiaolin
- Venue
- Tropical Medicine & International Health
- Publisher
- Wiley
- Published
- 2018-05-16
- Volume
- 23
- Issue
- 6
- Pages
- 668-677
- ISSN
- 1360-2276 (ISSN-L)
- 1365-3156
- OpenAlex
- W2801940919
- Cited by
- 71
- References
- 33
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 20 · 2023: 14 · 2022: 7 · 2021: 4 · 2020: 12 · 2019: 2
- FWCI
- 3.40
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Tropical Medicine & International Health (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Key Project of Scientific and Technology Program in Zhejiang (WKJ-ZJ-07)
- 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, social support, treatment interruption, treatment outcomes, medication adherence, directly observed therapy, financial support, stigma, psychological support, community health workers, Global Fund
- MeSH terms
- Assessment of Medication Adherence, Adult, China, Female, Humans, Male, Middle Aged, Retrospective Studies, Social Support, Treatment Outcome, Drug Monitoring, Tuberculosis, Multidrug-Resistant, Qualitative Research, Medication Adherence
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