Bridging the gap in multidrug-resistant tuberculosis care: a mixed-methods study of treatment outcomes, enrolment, and caregiver perspectives in Oyo State, Nigeria

Abstract

<title>Abstract</title> Background: Multidrug-resistant tuberculosis (MDR-TB) remains a major public health challenge, particularly in high-burden countries like Nigeria. Despite advances in diagnosis and treatment, gaps in treatment enrollment and completion continue to undermine control efforts. Problem Statement: Limited evidence exists on how caregiver perspectives and health system factors influence MDR-TB treatment enrolment and completion in Nigeria, particularly in subnational settings such as Oyo State. Methods: A descriptive cross-sectional mixed-methods study was conducted. Quantitative data were obtained from a retrospective review of 277 MDR-TB patient records (2016–2022), while qualitative data were collected through in-depth interviews with 10 caregivers, including healthcare workers, tuberculosis and leprosy supervisors, and community-based organization representatives. Descriptive statistics and chi-square tests were used for quantitative analysis, while thematic analysis was applied to qualitative data. Results: The majority of patients were aged ≥ 30 years (70.4%) and male (52.3%). Overall, 75.8% achieved favorable treatment outcomes (63.2% completed, 12.6% cured), while 24.2% experienced unfavorable outcomes, including loss to follow-up (11.6%) and death (6.9%). No significant associations were found between socio-demographic or clinical characteristics and treatment outcomes (p &gt; 0.05). Between 2020 and 2022, only 42.2% of detected MDR-TB cases were enrolled in treatment, despite improved enrolment rates in 2022 (51.3%). Qualitative findings identified key facilitators, including treatment effectiveness, counselling, free care, financial support, and strong health system engagement. Major barriers included poverty, stigma, long treatment duration, poor adherence, and disruption of livelihood. Conclusion: Although MDR-TB treatment success rates were relatively high, significant gaps remain in treatment enrolment and completion. Addressing socioeconomic barriers, strengthening patient support systems, and improving linkage between diagnosis and treatment are critical to enhancing MDR-TB outcomes. Clinical Trial Registration: Not applicable. This study was a descriptive cross-sectional mixed-methods study involving retrospective record review and qualitative interviews, and therefore did not require clinical trial registration.