{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:32:58Z","timestamp":1787319178094,"version":"build-2736575974"},"reference-count":43,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T00:00:00Z","timestamp":1736467200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Ototoxicity is a significant adverse effect associated with second-line anti-tuberculosis (TB) medications, particularly in treating extensively drug-resistant TB (XDR-TB). This study investigated the awareness of ototoxic effects among adults with XDR-TB undergoing treatment in South Africa, specifically exploring the role of information counselling on ototoxic symptoms, the timing of counselling, the content covered, and the management pathways available. This cross-sectional, descriptive qualitative study was conducted at Brooklyn Chest Hospital in the Western Cape. Ten adults with XDR-TB were purposively sampled and participated in semi-structured in-depth interviews. Data were thematically analyzed and the results revealed variability in information counselling on ototoxicity, with only 30% of participants receiving comprehensive counselling that specifically addressed ototoxic symptoms. The timing of counselling was inconsistent: while 70% of participants received some information before treatment, the remainder received counselling only after treatment initiation, which may have impacted early symptom recognition. Participants\u2019 awareness of ototoxic symptoms was generally limited, with most identifying hearing loss but few recognizing other symptoms such as tinnitus or dizziness. Furthermore, only 20% of participants were provided with clear referral pathways for symptom management. These findings highlight a gap in the depth, timing, and specificity of information counselling on ototoxic effects for XDR-TB in this context. Several interventions can be implemented to address this gap.<\/jats:p>","DOI":"10.3390\/ijerph22010091","type":"journal-article","created":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T10:06:38Z","timestamp":1736503598000},"page":"91","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A Cross-Sectional, Descriptive Qualitative Study of Information Counselling During Tuberculosis Treatment in South Africa: Awareness of XDR-TB Patients on Ototoxic Effects"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2681-1484","authenticated-orcid":false,"given":"Skyla Maria","family":"Arendse","sequence":"first","affiliation":[{"name":"School of Human & Community Development, Faculty of Humanities, University of the Witwatersrand, Johannesburg 2050, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6220-9606","authenticated-orcid":false,"given":"Katijah","family":"Khoza-Shangase","sequence":"additional","affiliation":[{"name":"School of Human & Community Development, Faculty of Humanities, University of the Witwatersrand, Johannesburg 2050, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"dlac029","DOI":"10.1093\/jacamr\/dlac029","article-title":"Acquired bedaquiline resistance during the treatment of drug-resistant tuberculosis: A systematic review","volume":"4","author":"Mallick","year":"2022","journal-title":"JAC-Antimicrob. Resist."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Matakanye, H., Tshitangano, T.G., Mabunda, J.T., and Maluleke, T.X. (2021). Knowledge, beliefs, and perceptions of TB and its treatment amongst TB patients in the Limpopo Province, South Africa. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph181910404"},{"key":"ref_3","first-page":"2100641","article-title":"Impact of the revised definition of extensively drug-resistant tuberculosis","volume":"58","author":"Veziris","year":"2021","journal-title":"Eur. Respir. J. Off. J. Eur. Soc. Clin. Respir. Physiol."},{"key":"ref_4","unstructured":"Matikinca, S. (2022). The Burden of Hearing Loss Amongst Multi-Drug Resistant-Tuberculosis Patients on Bedaquiline at Zithulele Hospital, Eastern Cape Province. [Master\u2019s Thesis, University of Limpopo]."},{"key":"ref_5","first-page":"823","article-title":"The lived experiences and psychosocial impact of hearing loss on the quality of life of adults with Multidrug-Resistant Tuberculosis","volume":"69","author":"Thusi","year":"2022","journal-title":"S. Afr. J. Commun. Disord."},{"key":"ref_6","first-page":"784","article-title":"Impact of drug-resistant tuberculosis treatment on hearing function in South African adults: Bedaquiline versus kanamycin","volume":"68","author":"Prodromos","year":"2021","journal-title":"S. Afr. J. Commun. Disord."},{"key":"ref_7","first-page":"9","article-title":"Ototoxicity as a side-effect of drugs: Literature review","volume":"10","author":"Skarzynska","year":"2020","journal-title":"J. Hear. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Khoza-Shangase, K., and Masondo, N. (2020). What are the current audiological practices for ototoxicity assessment and management in the south African healthcare context?. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17072613"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1809394","DOI":"10.1155\/2016\/1809394","article-title":"Cisplatin-associated ototoxicity: A review for the health professional","volume":"2016","author":"Paken","year":"2016","journal-title":"J. Toxicol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"46","DOI":"10.4103\/jpbs.JPBS_334_19","article-title":"In pursuit of preventive audiology in South Africa: Scoping the context for ototoxicity assessment and management","volume":"13","author":"Masondo","year":"2021","journal-title":"J. Pharm. Bioallied Sci."},{"key":"ref_11","unstructured":"Health Professions Council of South Africa (HPCSA) (2024, August 11). Audiological Management of Patients on Treatment that Includes Ototoxic Medications. HPCSA.CO.ZA. Available online: https:\/\/www.hpcsa.co.za\/Uploads\/professional_boards\/slh\/guidelines\/Guidelines_for_Audiological_Management_of_Patients_on_Treatment_that_includes_Ototoxic_Medications.pdf."},{"key":"ref_12","first-page":"685","article-title":"Perspectives and practices of ototoxicity monitoring","volume":"67","author":"Govender","year":"2020","journal-title":"S. Afr. J. Commun. Disord."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1093\/cid\/ciad596","article-title":"Genotype\u2013phenotype characterization of serial Mycobacterium tuberculosis isolates in bedaquiline-resistant tuberculosis","volume":"78","author":"Brown","year":"2024","journal-title":"Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am."},{"key":"ref_14","unstructured":"Khoza-Shangase, K., Mupawose, A., and Mlangeni, N.P. (2023, February 13). Ototoxic effects of tuberculosis treatments: How aware are patients? Academicjournals.org. Available online: https:\/\/academicjournals.org\/journal\/AJPP\/article-full-text-pdf\/90357F435693."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Sparg, T., Petersen, L., Mayers, P., and Rogers, C. (2024). South African adolescents\u2019 lived experiences of acquired hearing loss following multidrug-resistant tuberculosis treatment. Front. Rehabil. Sci., 5.","DOI":"10.3389\/fresc.2024.1336346"},{"key":"ref_16","unstructured":"Khoza-Shangase, K. (2022). Ototoxicity Vigilance as a Preventive Audiology Imperative Within the African Context: Pharmaco-Audiology explored. Preventive Audiology: An African Perspective, AOSIS Books."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Paken, J., Govender, C.D., Pillay, M., and Sewram, V. (2022). Cisplatin-associated ototoxicity: Perspectives from a single institution cervical cancer cohort and implications for developing a locally responsive monitoring programme in a public healthcare setting. BMC Health Serv. Res., 22.","DOI":"10.1186\/s12913-022-08099-8"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.otorri.2019.12.003","article-title":"The impact of medical interventions for reducing ototoxicity during treatment for multi-drug resistant tuberculosis","volume":"71","author":"Lecheko","year":"2020","journal-title":"Acta Otorrinolaringol. Esp."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"171","DOI":"10.4103\/jpbs.JPBS_17_17","article-title":"Risk versus benefit: Who assesses this in the management of patients on ototoxic drugs?","volume":"9","year":"2017","journal-title":"J. Pharm. Bioallied Sci."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Muhammad, S.I., Eboreime, E.A., Ogbonna, V.I., Zubairu, I., and Ibisomi, L. (2022). Clinical guidelines for managing hearing loss as a complication of drug-resistant tuberculosis treatment: An evaluation of implementation fidelity in Kano, Nigeria. BMC Health Serv. Res., 22.","DOI":"10.1186\/s12913-022-07536-y"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/s12960-020-00488-6","article-title":"Sustainable workforce: South African audiologists and speech therapists","volume":"18","author":"Pillay","year":"2020","journal-title":"Hum. Resour. Health"},{"key":"ref_22","unstructured":"Khoza-Shangase, K. (2022). Challenges and complexities with assessment and management of ototoxicity in South Africa. Complexities and Challenges. Preventive Audiology: An African Perspective, AOSIS Books."},{"key":"ref_23","first-page":"2140","article-title":"Ototoxicity in tuberculosis treatment in South Africa: Exploring the current status","volume":"7","year":"2013","journal-title":"Afr. J. Pharm. Pharmacol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1016\/j.ijporl.2015.04.040","article-title":"The occurrence of auditory dysfunction in children with TB receiving ototoxic medication at a TB hospital in South Africa","volume":"79","author":"Ghafari","year":"2015","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"364","DOI":"10.4102\/safp.v57i6.4279","article-title":"Practices employed by audiologists in the management of adult patients with multidrug-resistant tuberculosis in South Africa","volume":"57","author":"Govender","year":"2015","journal-title":"S. Afr. Fam. Pract."},{"key":"ref_26","first-page":"44","article-title":"Audiological testing for ototoxicity monitoring in adults with tuberculosis in state hospitals in Gauteng, South Africa","volume":"31","author":"Stirk","year":"2016","journal-title":"South. Afr. J. Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Stevenson, L.J., Biagio-de Jager, L., Graham, M.A., and Swanepoel, D.W. (2021). Community-based ototoxicity monitoring for drug-resistant tuberculosis in South Africa: An evaluation study. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph182111342"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"5187","DOI":"10.4102\/safp.v63i1.5187","article-title":"Ototoxicity: A review of South African studies","volume":"63","author":"Moodley","year":"2021","journal-title":"S. Afr. Fam. Pract."},{"key":"ref_29","first-page":"886","article-title":"A longitudinal community-based ototoxicity monitoring programme and treatment effects for drug-resistant tuberculosis treatment, Western Cape","volume":"69","author":"Stevenson","year":"2022","journal-title":"S. Afr. J. Commun. Disord."},{"key":"ref_30","first-page":"1064","article-title":"Healthcare professionals\u2019 knowledge and practices in managing ototoxicity in children with cancer","volume":"71","author":"Ramnarian","year":"2024","journal-title":"S. Afr. J. Commun. Disord."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Koh, E.T., Owen, W.L., Koh, E.T., and Owen, W.L. (2000). Descriptive research and qualitative research. Introduction to Nutrition and Health Research, Springer.","DOI":"10.1007\/978-1-4615-1401-5"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1177\/1362168820941288","article-title":"Good qualitative research","volume":"24","author":"Nassaji","year":"2020","journal-title":"Lang. Teach. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1177\/1744987120927206","article-title":"Purposive sampling: Complex or simple? Research case examples","volume":"25","author":"Campbell","year":"2020","journal-title":"J. Res. Nurs."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1111\/j.1365-2929.2006.02418.x","article-title":"The qualitative research interview","volume":"40","author":"Crabtree","year":"2006","journal-title":"Med. Educ."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual. Res. Psychol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"254","DOI":"10.4304\/tpls.3.2.254-262","article-title":"Mixed Method research: Instruments, validity, reliability and reporting findings","volume":"3","author":"Zohrabi","year":"2013","journal-title":"Theory Pract. Lang. Stud."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1177\/160940690600500107","article-title":"Demonstrating rigor using thematic analysis: A hybrid approach of inductive and deductive coding and theme development","volume":"5","author":"Fereday","year":"2006","journal-title":"Int. J. Qual. Methods"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"494","DOI":"10.3390\/jcp4030024","article-title":"Data Privacy and Ethical Considerations in Database Management","volume":"4","author":"Pina","year":"2024","journal-title":"J. Cybersecur. Priv."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s12992-020-00657-1","article-title":"Towards TB elimination: How are macro-level factors perceived and addressed in policy initiatives in a high burden country?","volume":"17","author":"Adu","year":"2021","journal-title":"Glob. Health"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"101055","DOI":"10.1016\/j.cegh.2022.101055","article-title":"Health counselling support medication adherence to regular pulmonary tuberculosis patients","volume":"15","author":"Efendi","year":"2022","journal-title":"Clin. Epidemiol. Glob. Health"},{"key":"ref_41","first-page":"e1","article-title":"Language and culture in speech-language and hearing professions in South Africa: The dangers of a single story","volume":"65","author":"Mophosho","year":"2018","journal-title":"S. Afr. J. Commun. Disord."},{"key":"ref_42","first-page":"250","article-title":"Ototoxicity monitoring in general medical practice: Exploring perceptions and practices of general practitioners about drug-induced auditory symptoms","volume":"1","author":"Jina","year":"2013","journal-title":"Innov. Pharm. Pharmacother."},{"key":"ref_43","unstructured":"World Health Organization (2019). WHO Consolidated Guidelines on Drug-Resistant Tuberculosis Treatment (No. WHO\/CDS\/TB\/2019.7), World Health Organization."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/1\/91\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:26:42Z","timestamp":1759919202000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/1\/91"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,10]]},"references-count":43,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["ijerph22010091"],"URL":"https:\/\/doi.org\/10.3390\/ijerph22010091","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,10]]}}}