Hidden drug side effects threaten TB treatment in India

Adverse drug reactions (ADRs) are a major obstacle to successful tuberculosis (TB) care: they make people less likely to stick with treatment, prolong illness, and raise the risk of treatment failure and death. To better understand how common these problems are and how they affect different people, Ridhima Sodhi led a mixed-methods study across six states in India. The research team combined in-depth ethnographic observations and interviews with 40 patients and local stakeholders in three districts, with a large quantitative survey of 2,000 randomly selected TB patients across eight districts. The qualitative work uncovered a new way to think about drug side effects: 'active' ADRs are urgent, acute problems that need immediate care, while 'passive' ADRs are lower-intensity, persistent conditions that quietly erode a patient’s ability to continue treatment. Examples of passive ADRs include skin darkening and long-lasting fatigue. By pairing personal stories with broad survey data, the study aimed to map who experiences which kinds of ADRs, how long they last, and how current care systems respond.

The study used a sequential mixed-methods design: ethnography and interviews informed the survey, and the large-scale quantitative data tested how common different ADRs are across patient groups. Results showed a near-universal burden of side effects: 86% of patients reported at least one ADR (Mean = 3.1, SD 2.38). Women reported ADRs more frequently and for longer durations, with cutaneous ADRs especially common among women. Older patients were more likely to report gastrointestinal and musculoskeletal ADRs. Younger patients and women reported the highest prevalence of vomiting (41%). In statistical analysis, vomiting was the only independent predictor of unsuccessful treatment completion (OR = 0.39, 95% CI: 0.20–0.76). The overall number of ADRs was also linked to worse treatment outcomes (OR = 0.88, 95% CI: 0.78–0.98). These quantitative findings reinforced the active–passive taxonomy from the interviews and showed clear patterns by age and gender.

The study’s findings point to practical changes that could improve TB care. The active–passive ADR taxonomy, together with the risk-group patterns by age and gender, suggests a path toward more patient-centered management: structured, risk-based counselling at different treatment stages, targeted support for women and younger patients who report more vomiting, and focused attention to older patients’ gastrointestinal and musculoskeletal side effects. The authors recommend embedding these ideas in national TB guidance, including the National TB Elimination Frameworks (NTEP), and training treatment coordinators and providers to deliver differentiated counselling and proactive ADR management. While the paper calls for more research on scalability and cost-effectiveness, it argues that structured ADR management is both urgent and feasible in high-burden settings—and that attention to persistent, low-intensity ‘passive’ ADRs could pay big dividends for adherence and treatment success.