Health-related quality of life among tuberculosis patients under Revised National Tuberculosis Control Programme in rural and urban Puducherry

Tuberculosis impacts multiple aspects in quality of life in a Romanian cohort of drug-susceptible and drug resistant patients: A patient-reported outcome measures study

BACKGROUND

Tuberculosis (TB), and especially its drug resistant forms, is responsible for not only significant mortality, but also considerable morbidity, still under-quantified. This study used four Patient-Reported Outcome Measures (PROMS) to assess the status of persons affected by drug-susceptible and drug-resistant TB during their TB treatment or after treatment completion, in Romania, the highest TB burden country in the EU.

METHODS

People affected by TB in two different regions in Romania were included during and after treatment, following a cross-sectional design. PROMs used were SF-36, EQ-5D-5L, WPAI and the app-based audiometry screening tool 'uHear.' Descriptive statistics and relevant statistical tests were used to compare groups between themselves and with the general Romanian population.

RESULTS

Both patients with drug-susceptible and drug-resistant TB experience, with drug-resistant patients experiencing statistically significantly more pain and hearing loss. PROMs show some improvement in the after-treatment group; however, compared with the general Romanian population for which data were available, all groups scored lower on all outcome measures.

CONCLUSION

PROMs offer the possibility of obtaining a more comprehensive view of patients' status, by involving them directly in the medical process and could guide a rehabilitation strategy.

Effectiveness of family support health education intervention to improve health-related quality of life among pulmonary tuberculosis patients in Melaka, Malaysia

BACKGROUND

Pulmonary Tuberculosis (PTB) is an important public health problem in Malaysia. In this country, limited research has been carried out on the impact of the disease on the health-related quality of life (HRQoL). Family support interventions had been shown to be effective in improving the PTB treatment outcomes.

OBJECTIVES

This study aims to determine the effectiveness of a newly developed Family Support Health Education (FASTEN) intervention in improving the health-related quality of life (HRQoL) among PTB patients in Melaka, as compared to the current conventional disease management.

MATERIALS AND METHODS

A single-blinded, randomized controlled field trial study design was conducted in Melaka from September 2019 until August 2021, involving newly diagnosed PTB patients. The participants were randomized either into the intervention group (FASTEN intervention) or into the control group (conventional management). They were interviewed by using a validated questionnaire that includes the Short Form 36 Health Survey version 2 (SF-36v2), at three time points: at diagnosis, two months and six months after diagnosis. Data were analyzed using IBM SPSS Statistics for Windows version 24. The Generalized Estimating Equations (GEE) analysis was used to evaluate the effectiveness of the intervention, in terms of the HRQoL score difference between the groups, adjusted for baseline covariates.

RESULTS

The HRQoL among PTB patients was lower than the HRQoL of general Malaysian population. Among the total 88 respondents, the three lowest HRQoL domains scores at baseline were Social Functioning (SF), Role limitation due to Physical condition (RP) and Vitality (VT) with the median (IQR) scores of 27.26 (10.03), 30.21 (11.23) and 34.77 (8.92) respectively. The median (IQR) for Physical Component Score (PCS) was 43.58 (7.44) and for Mental Component Score (MCS) was 40.71 (8.77). There were significant difference in the HRQoL median scores between the intervention group compared to the control group, as the Physical Functioning (PF) (p = 0.018), RP (p < 0.001), General Health (GH) (p < 0.001), VT (p < 0.001), SF (p < 0.001), Role limitation due to Emotional condition (RE) (p < 0.001), General Mental Health (MH) (p < 0.001), and the MCS (p < 0.001).

CONCLUSION

The FASTEN intervention is effective to improve the overall HRQoL among PTB patients, as the HRQoL scores were significantly higher in the intervention group compared to the control group who received conventional management. Therefore, it is recommended that the TB program should incorporate the involvement of family members in the patient's management.

DATE OF REGISTRATION AND NUMBER

The protocol was registered with RCT registered body on 05/12/2019 (Australian New Zealand Clinical Trial Registry - Registration Number: ACTRN12619001720101).

Cost Effectiveness of a Shorter Moxifloxacin Based Regimen for Treating Drug Sensitive Tuberculosis in India

Globally efforts are underway to shorten the existing 6-month tuberculosis (TB) treatment regimen for drug-sensitive patients, which would be equally effective and safe. At present, there is a lack of evidence on the cost implications of a shorter 4-month TB regimen in India. This economic modeling study was conducted in the Indian context with a high TB burden. We used a hybrid economic model comprising of a decision tree and Markov analysis. The study estimated the incremental costs, life years (LYs), and quality-adjusted life years (QALYs) gained by the introduction of a Moxifloxacin-based shorter 4-month treatment regimen for pulmonary TB patients. The outcomes are expressed in incremental cost-effectiveness ratios (ICERs) per QALYs gained. The cost per case to be treated under the 4-month regimen was USD 145.94 whereas for the 6-month regimen it was USD 150.39. A shorter 4-month TB regimen was cost-saving with USD 4.62 per LY and USD 5.29 per QALY. One-way sensitivity analysis revealed that the cost of the drugs for the 4-month regimen, hospitalization cost for adverse drug reactions, and human resources incurred for the 6-month regimen had a higher influence on the ICER. The probability sensitivity analysis highlighted that the joint incremental cost and effectiveness using QALY were less costly and more effective for 67% of the iteration values. The cost-effectiveness acceptability curve highlights that the 4-month regimen was dominant to both patients and the National TB Elimination Programme in India as compared to the 6-month regimen at different cost-effectiveness threshold values.

Health-Related Quality of Life (HRQoL) of Patients with Tuberculosis: A Review

Tuberculosis (TB) is a major killer and cause of human suffering worldwide and imposes a substantial reduction in patients’ health-related quality of life (HRQoL). HRQoL indicates the consciousness of patients regarding their physical and mental health. It is, therefore, very relevant in comprehending and measuring the exact impact of the disease state. Therefore, we undertook this review to summarize the available evidence on the impact of TB and its treatment on HRQoL. An in-depth understanding of HRQoL in TB patients can identify the existing management gaps. We undertook a systematic search through PubMed and CENTRAL. Data were extracted and tabulated for study design, targeted population, QoL instrument used, QoL domain assessed, and key findings. We included studies that assessed the effect of TB on the QoL both during and after treatment. There are no specific HRQoL assessment tools for utilization among TB patients. HRQoL is markedly impaired in patients with TB. The factors affecting HRQoL differ with active and latent TB, socio-demographics, socio-economic status, presence of co-infections, etc. This review’s findings can help to frame appropriate policies for tackling HRQoL issues in TB patients.

An exploratory mixed method study on the follow up status and quality of life among recurrent tuberculosis patients in South India

INTRODUCTION

After completion of treatment of Tuberculosis (TB), many patients can have long-term physical sequelae, which in some cases results in life-long impairment and further stigma.

OBJECTIVES

To determine the follow up status and quality of life of post-treatment among Category 2 TB patients under RNTCP and to explore the factors affecting the Quality of Life.

MATERIAL AND METHODS

The present study was done in urban area of Villupuram district of Tamil Nadu using Exploratory mixed methods study design. In the first phase case-control study was conducted with 100 post treatment category 2 TB patients (cases) and 100 non-TB patients (controls) matched for age and gender. The quality of life of the respondents was assessed by (WHOQOL-BREF) questionnaire (Quantitative), followed by five in-depth interviews among cases with extreme scores (Qualitative).

RESULTS

The mean scores of "perceived physical health" and "perceived psychological health" among cases after completion of treatment was significantly lower than the mean scores in controls. The determinants for perceived physical health were age, years of education and marital status. The determinants for psychological health were age, marital status and associated comorbidities. In-depth interview explored that major perspectives of cases affecting quality of life were side effects of drugs, loss of social support, loss of employment and psychological factors like anxiety, depression.

CONCLUSIONS

HR-QOL among post treatment TB patients was reduced. Efforts should be made to counsel TB patients, family members, relatives and their workplace regarding their care, support and challenges to have a reasonable QOL.

Quality of life with tuberculosis

Tuberculosis diagnosis and treatment currently revolves around clinical features and microbiology. The disease however adversely affects patients’ psychological, economic, and social well-being as well, and therefore our focus also additionally needs to shift towards quality of life (QOL). The disease influences all QOL domains and substantially adds to patient morbidity, and these complex and multidimensional interactions pose challenges in accurately quantifying impairment in QOL. For this review, PubMed database was queried using keywords like quality of life, health status and tuberculosis, and additional publications identified by a bibliographic review of shortlisted articles. Both generic and specific QOL scales show a wide variety of derangements in scores, and results vary across countries and patient groups. In particular, diminished capacity to work, social stigmatization, and psychological issues worsen QOL in patients with tuberculosis. Although QOL has been consistently shown to improve during standard anti-tubercular therapy, many patients continue to show residual impairment. It is also not clear if specific situations like presence of comorbid illnesses, drug resistance, or co-infection with human immunodeficiency virus additionally worsen QOL in these patients. There is a definite need to incorporate QOL assessment as adjunct outcome measures in tuberculosis control programs. Governments and program managers need to step up socio-cultural reforms and health education, and provide additional incentives to patients, to counter impairment in QOL.

Quality of life and its effective factors in tuberculosis patients receiving directly observed treatment short-course (DOTS)

Background

Quality of life in patients affected with chronic diseases has developed into a therapeutic objective as the best tool to evaluate response to treatment and medical care. The purpose of this study was to evaluate quality of life and its related factors in tuberculosis patients receiving directly observed treatment short-course in Iran.

Methods

This was a cross-sectional research with a descriptive-analytic design. Sample size included 71 patients affected with tuberculosis based on census method; so that, at the time of the study, all the tuberculosis patients were recruited in this research. The data collection instrument was a questionnaire comprised of two parts including demographic characteristics information and standard 36-Item Short Form Health Survey (SF-36). The data were also analyzed using SPSS Statistics along with descriptive and analytic statistics and independent t-tests, analysis of variance (ANOVA), and Chi-square test.

Results

The lowest mean score was 63.58 ± 10.16 and 62.82 ± 15.2 related to limited physical activity following mental problems and social functioning, respectively. Furthermore, the findings of the independent t-test demonstrated that the mean scores of quality of life among men and women, those with pulmonic and non-pulmonic tuberculosis, patient's place of residence and the stage of treatment were statistically and significantly different.

Conclusion

According to the above results, tuberculosis and its treatment have impact on the social function, mental, and emotional aspects of the quality of life of patients, Attention to and monitoring of the quality of life as a follow up of the treatment and care intervention in these patients is necessary.