Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
Int J Tuberc Lung Dis. 2020 Jan 1;24(1):43-47. doi: 10.5588/ijtld.19.0207.
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. To elicit adolescent experiences of MDR-TB diagnosis and treatment with qualitative body-mapping activities and discussions. 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. 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). 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.
耐多药结核病（MDR-TB）青少年患者的治疗耐受性研究较少。我们呈现了来自南非西开普省参与观察性队列研究的青少年的定性研究数据。采用定性身体映射活动和讨论，了解青少年对 MDR-TB 诊断和治疗的体验。MDR-TB 观察性队列中的青少年接受了临床医生的常规毒性和听力筛查。我们招募了 8 名参与者（10-16 岁），以参与额外的身体映射活动和深入访谈。采用主题演绎分析。我们比较了临床评估和定性讨论。青少年参与者报告标准毒性和听力报告的不良影响很少。只有恶心和呕吐在>10%的病例中报告，且均为 1 级（无/最小干扰）不良事件（AE）。然而，当将毒性报告与定性身体映射活动和访谈进行比较时，我们发现了以前未报告的 AE（感觉神经改变、神经肌肉无力、疼痛）；低估了 AE 的严重程度（恶心、瘙痒）；以及遗漏了心理社会症状（抑郁迹象）。接受 MDR-TB 治疗的青少年经历了未在常规临床评估中报告的与治疗相关的 AE。青少年的心理社会体验未被考虑在内。需要进一步研究以了解这一弱势群体的体验。我们建议药物安全监测应适应包括儿童在内的弱势群体，采用更具创造性和以患者为中心的报告机制。
