Social determinants across the MDR/RR-TB care cascade: a critical narrative review

Introduction and aim Multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB) remains a major public health challenge, particularly in the WHO European Region. This critical narrative review examines how social determinants influence the clinical course and outcome of patients across the MDR/RR-TB care cascade, from access to diagnosis and treatment initiation to treatment support, retention in care. Methodology/Scope Researchers reviewed the current publications on the topic of our review until June 2026. Sources were prioritized on the basis of relevance to MDR/RR-TB, social determinants, and care-cascade outcomes. Evidence from broader TB populations was used only when MDR/RR-TB-specific data were limited and is identified as such. Main findings Across settings, poverty, catastrophic total costs, homelessness, incarceration, stigma, education, mental-health difficulties, substance use, and barriers related to legal status, mobility, language, insurance, and access to care were associated with delayed diagnosis. Material, psychosocial, and individualized treatment support may improve retention and outcomes, but much of the evidence is observational and context-specific. Conclusion Social determinants should be addressed throughout the MDR/RR-TB care cascade through patient-centered models that combine effective regimens with financial, psychosocial, housing, and individualized adherence support. The evidence base remains heterogeneous, and causal claims should be interpreted cautiously.