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

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.

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.

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.

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.