Socio-economic drivers of Drug-Resistant Tuberculosis in Africa: A Scoping Review
Abstract Background Drug-resistant TB (DR-TB) remains a public health concern due to the high morbidity and mortality rates from the disease. The DR-TB is a multifaceted illness with expensive treatment regimens, toxic medications and most often the long duration of treatment constitutes a substantial financial burden on both infected patients and the health system. Despite significant research advances so far in the diagnosis and treatment, there is a paucity of synthesized evidence on how socio-economic factors are associated with DR-TB. This review aims to address this gap by synthesizing available evidence and data on the main socio-economic drivers of DR-TB infection in Africa. Methods We conducted a systematic search on PUBMED and Google Scholar databases from January 2011 to March 2020 using Joanna Briggs Institute’s scoping review approach. Our eligibility criteria only included systematic reviews and studies conducted with quantitative research methods (cross-sectional, case-control, cohort and randomized-control trials) in this review. We also considered studies conducted in Africa and focused on socio-economic factors influencing DR-TB burden in African countries. Data was extracted from all the studies that met the eligibility criteria based on the study’s objectives. Results Out of the 154 articles that were retrieved for review, 20 abstracts of these articles met all the eligibility criteria and were fully reviewed. Of the 20 articles, one was a mixed-method study, 16 quantitative and 3 reviews. The following themes were identified as major findings: Social and economic drivers associated with DR-TB. Substance abuse of which, stigma and discrimination were the prominent social drivers. Economic drivers included poverty, financial constraints because of job loss, loss of productive time during hospital admission and treatment costs. Conclusion Our findings provide insights on the socio-economic drivers of DR-TB burden. This is relevant to assist DR-TB management program and TB stakeholders in different settings to address identified socio-economic gaps and to reduce its negative impact on the programmatic management of DR TB. Therefore, redirecting strategies with more focus on socio-economic empowerment of DR-TB patients could be one of the innovative solutions to reduce the spread and eliminate DR-TB in Africa.