Key populations for multidrug-resistant TB (MDR-TB) face heightened vulnerability due to social, behavioral, and structural barriers, such as poverty, substance use and stigma. Here we illustrate the difficulties faced with a composite personal narrative based on the experiences of two participants in a clinical trial of adherence support interventions for people with MDR-TB and HIV. Addressing these factors through tailored interventions is crucial to improving care engagement and challenging one-size-fits-all approaches to TB prevention.