Psychosocial Support Improves Treatment Adherence Among MDR-TB Patients: Experience from East Kazakhstan
Open accessAbstract
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 number of 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. In conclusion, our patient–oriented support program was successful in reducing rates of treatment default among MDRTB patients.
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Kaliakbarova et al. described operational challenges, including heavy workloads, resource constraints, and implementation demands that could undermine intervention delivery despite good intentions and financial support.
“Kaliakbarova et al. [36] likewise described operational challenges, including heavy workloads, resource constraints, and implementation demands that could undermine intervention delivery despite good intentions and financial support.”
From Psychosocial Interventions for Improving Treatment Adherence in Tuberculosis Patients: A Scoping Review of Evidence-Based Approaches. (2026) · cites this paper as [36]
The Introduction reports limited local budgets, and the Psychosocial Support Groups section says the two groups could not reach everyone needing support, especially in remote areas. The Recommendations also call for resources and clearer implementation guidance. The paper does not describe heavy workloads or say that good intentions and financial support were insufficient to deliver the intervention. (LLM, conf=0.85)
Experimental — accuracy not yet measuredAdditional engagement strategies supported by the reviewed literature include the use of incentives and enablers, peer support workers with lived experience of TB or substance use, multidisciplinary teams that combine clinical, psychological, and social work roles, and culturally tailored education delivered at multiple levels.
“Additional engagement strategies supported by the reviewed literature include the use of incentives and enablers (e.g., transport vouchers, food parcels, hygiene kits), peer support workers with lived experience of TB or substance use, multidisciplinary teams that combine clinical, psychological, and social work roles, and culturally tailored education delivered at multiple levels (patient, family”
From Psychosocial Interventions for Improving Treatment Adherence in Tuberculosis Patients: A Scoping Review of Evidence-Based Approaches. (2026) · cites this paper as [36]
The Psycho-Social Support Groups section describes food and hygiene parcels and a team of psychologists, social workers, and TB nurses; the Discussion also describes patient education. The cited paper does not describe peer support workers with lived experience, transport vouchers, or culturally tailored education delivered at multiple levels. Page numbers were not provided in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredImplementation of a structured psychosocial support (PSS) program in Kazakhstan was associated with reductions in default rates and improvements in dose adherence during the program rollout period.
“Similarly, the implementation of a structured psychosocial support (PSS) program in Kazakhstan was associated with reductions in default rates and improvements in dose adherence during the program rollout period [36].”
From Psychosocial Interventions for Improving Treatment Adherence in Tuberculosis Patients: A Scoping Review of Evidence-Based Approaches. (2026) · cites this paper as [36]
Multicomponent interventions combining psychological support, education, and material or social assistance have apparent value for addressing multidimensional adherence barriers.
“The multidimensional nature of adherence barriers is also reflected in the apparent value of multicomponent interventions combining psychological support, education, and material or social assistance [16,19,36].”
From Psychosocial Interventions for Improving Treatment Adherence in Tuberculosis Patients: A Scoping Review of Evidence-Based Approaches. (2026) · cites this paper as [36]
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- Authors
- Kaliakbarova, G., Pak, S., Zhaksylykova, N., Raimova, G., Temerbekova, B., & Hof, S. V. D.
- Affiliations
- Bentham Science Publishers (United Arab Emirates) (AE)
- KNCV TB Plus (NL)
- Amsterdam UMC Location University of Amsterdam (NL)
- Corresponding author
- Kaliakbarova, G.
- ORCID
- Hof, S. van den
- Venue
- The Open Infectious Diseases Journal
- Publisher
- Bentham Science Publishers Ltd.
- Published
- 2013-04-19
- Volume
- 7
- Issue
- 1
- Pages
- 60-64
- ISSN
- 1874-2793 (ISSN-L)
- OpenAlex
- W2034271010
- Cited by
- 40
- References
- 10
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 2 · 2023: 1 · 2022: 4 · 2021: 11 · 2020: 3 · 2019: 4 · 2018: 3 · 2017: 4 · 2016: 3
- FWCI
- 0.73
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- The Open Infectious Diseases Journal (publishedVersion, cc-by)
- Funders
- United States Agency for International Development
- 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, medication adherence, treatment default, patient-centered care, second-line antituberculosis drugs, dose splitting, East Kazakhstan
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