Household structures and exposure networks among people with multidrug-resistant TB in Namibia

Background: Multidrug-resistant TB (MDR-TB) poses major challenges for TB control in high-TB-burden settings such as Namibia. In southern Africa, family and household structures are fluid, yet little is known about how MDR-TB interacts with these structures. We therefore explored family structures, household changes, and implications for transmission and care among people living with MDR-TB in Namibia.

Methods: We conducted a qualitative sub-study within the Hotspots, Hospitals and Households (H3TB) transmission of TB project. Between June 2021 and August 2023, 119 participants with MDR-TB were recruited from three regions of Namibia. In-depth interviews using participatory kinship, social network, and community mapping tools were conducted. Data were thematically analysed, with case studies illustrating household reconfigurations.

Results: We identified 11 household structure patterns. Fourteen participants reported changes in household composition following MDR-TB diagnosis, driven by moving closer to health services, reorganising to optimise family care, reducing perceived exposure risks, and mitigating financial strain. These reconfigurations altered co-residence patterns and potential TB contact networks, with implications for household-based active case finding.

Conclusion: MDR-TB acts as a stressor prompting household reorganisation, reshaping networks of exposure, care, and support. Accounting for dynamic household contexts may strengthen TB contact tracing and patient support strategies.