What is it about?
This is the first ever study to assess incidence and impact of ADRs among patients with drug-sensitive forms of Tuberculosis. Using a mixed methods study design, the study introduces a novel active-passive ADR taxonomy, collates risk-stratified patient profiles, and provides for a differentiated counselling framework which can be adapted by different TB programs globally.
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Why is it important?
The study addresses a critical and under-examined dimension of TB care: ADRs among patients receiving first-line drugs (FLDs). While there exists significant global literature on ADRs among patients with drug-resistant TB, similar evidence for those on FLDs remains limited. This is despite the fact that the latter constitute the overwhelming majority of the TB burden worldwide, accounting for over 10 million cases annually. Among many novel findings, the study introduces an active-passive ADR taxonomy, distinguishing between active (high-intensity, initial treatment weeks), and passive (low-intensity, late occuring, peristent) ADRs. The latter include effects such as persistent fatigue and skin darkening - ADRs which are often classified as mild and therefore receive limited clinical or programmatic attention. The results, however, demonstrate that such passive ADRs accumulate over time and materially undermine treatment adherence, revealing a critical gap in existing patient-centric TB care frameworks. Finally, the study provides granular demographic disaggregation of ADR incidence across patient profiles, enabling more targeted counselling, risk stratification, and timely remedial action. This evidence is directly relevant for programmatic prioritization and supports the design of differentiated ADR management strategies.
Perspectives
This study is distinctive in the way it not just captures qualitative patient experiences, but also validates the insights across a larger and representative sample. The generated evidence, in turn, is directly applicable to national TB programs globally. ADRs remain a persistent challenge to TB elimination efforts, particularly because they often continue well after TB-related symptoms have resolved. In such contexts, patients may perceive themselves as already cured, which can then rationalize skipping medication, especially in the face of persistent ADRs. The findings suggest that early information dissemination on ADRs, if integrated into routine counselling, can play a critical role in addressing this challenge. Preparing patients in advance for the likelihood, nature, and expected course of ADRs can help normalize their experiences, reduce uncertainty, and reinforce the importance of completing the full treatment regimen despite temporary discomfort.
Ridhima Sodhi
Clinton Foundation
Read the Original
This page is a summary of: Adverse drug reactions in tuberculosis treatment: Incidence, duration and resolution pathways from a mixed-methods patient-centric study in India, PLOS Global Public Health, December 2025, PLOS,
DOI: 10.1371/journal.pgph.0004149.
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