Care and social support from family and community in patients with pulmonary tuberculosis in Pakistan

Evaluating Treatment Outcomes and Tuberculosis Infection Risks: A Comparative Study of Centralized Hospitalization vs. Home-Based Treatment

Background: Guizhou Province in Southwest China has experimented with a centralized hospitalization (CH) treatment for active and severe cases of pulmonary tuberculosis (PTB). The objective of this study was to compare treatment outcomes of patients with tuberculosis (TB) receiving care in a CH setting with those receiving home-based (HB) care. In addition, this study aimed to assess the probability of their household contacts contracting tuberculosis infection. Method: A retrospective review of medical records was undertaken for patients with TB who completed their treatment in four counties in Guizhou, China, spanning from January 2022 to August 2023. In addition, a cross-sectional survey was conducted on the tuberculin skin test (TST) among household contacts of new patients with TB who had completed their treatment. Results: In the retrospective study, 94.8% had successful CH treatment, and 93.1% had successful HB treatment (p value = 0.70). In the prospective study, 559 and 448 household contacts of patients receiving CH treatment had 16 positive and 89 negative TST results, whereas those with HB treatment showed 26 positive and 74 negative TST results. Regarding a logistic regression analysis, the CH group was nearly two times more likely to test negative on the TST, 1.95 (95% CI: 0.98, 3.92). After adjusting for confounding variables, the odds ratio increased significantly to 4.42 (95% CI: 1.22, 16.04). Conclusions: CH for treatment of TB did not show superior success rates, but it may reduce the risk of transmitting tuberculosis infection to household contacts compared to home treatment.

Factors determining family and social support among pulmonary tuberculosis patients in East Khasi Hills, Meghalaya: a cross-sectional study

INTRODUCTION

Family support plays a vital role in the outcome of individuals with tuberculosis (TB).

OBJECTIVES

To determine the family and social support among individuals with pulmonary TB during treatment.

METHODS

A cross-sectional survey was conducted among 237 pulmonary TB patients currently in the continuous phase of treatment. Bivariate and multivariate analyses were conducted to determine the association and predictors for family and social support. P-value < 0.05 was considered statistically significant.

RESULTS

The mean age of the respondents was 31.97 ± 12.51 years, and a majority (58.2%) of the respondents with TB disease were 18 to 38 years old, and 59.9% were males. Around 49.7% of the pulmonary TB patients received a high level of family support, whereas 73% received a high level of social support. The determinants like age, average monthly income, the educational level of the head of the family and the occupational level of both the patients and the head of the family are associated with family support.

CONCLUSION

This study recommends a coordinated strategy to treat TB that involves not only professional services but also the vital social support network of family and community that is required throughout therapy.

Association between concern about COVID-19, social support and knowledge about tuberculosis with adherence to antituberculosis treatment in Lima, Perú

INTRODUCTION

In the context of the COVID-19 pandemic, information on factors associated with adherence to antituberculosis treatment in areas with high prevalence of tuberculosis is scarce.

OBJETIVE

To evaluate whether there is an association between social support, concern about COVID-19 infection and knowledge about tuberculosis, and non-adherence to antituberculosis treatment.

MATERIALS AND METHODOS

A cross-sectional study was carried out on patients under antituberculosis treatment, from January to March, 2022, in centers located in areas with a high prevalence of tuberculosis in Lima. We used the Morisky Green-Levine questionnaire to assess adherence to treatment as the dependent variable; the independent variables were evaluated using the Medical Outcomes Study Social Support Survey for perceived social support and concern about COVID-19 infection, and the Battle Test to assess patients’ knowledge about their disease. We used Poisson regression with robust variance to evaluate the association between the independent variables and the dependent one.

RESULTS

Out of 101 participants (73.3% male with an average age of 35.1 ± 16 years), 51.5% were non-adherent to antituberculosis treatment. Medium or high level of concern about getting COVID-19 was associated with a higher prevalence of non-adherence to treatment (odds ratio: 1.68; 95 % confidence interval: 1.09-2.57) (adjusted for considered confounding variables).

CONCLUSIONS

Non-adherence is a frequent condition among patients living in an area with a high prevalence of tuberculosis in Lima, especially among those with a higher concern for COVID-19 infection.

A study on tuberculosis disease disclosure patterns and its associated factors: Findings from a prospective observational study in Chennai

BACKGROUND

Disclosure of tuberculosis (TB) status by patients is a critical step in their treatment cascade of care. There is a lack of systematic assessment of TB disclosure patterns and its positive outcomes which happens dynamically over the disease period of individual patients with their family and wider social network relations.

METHODS

This prospective observational study was conducted in Chennai Corporation treatment units during 2019-2021. TB patients were recruited and followed-up from treatment initiation to completion. Information on disease disclosures made to different social members at different time points, and outcomes were collected and compared. Bivariate and multi variate analysis were used to identify the patients and contact characteristics predictive of TB disclosure status.

RESULTS

A total of 466 TB patients were followed-up, who listed a total of 4039 family, extra familial and social network contacts of them. Maximum disclosures were made with family members (93%) and half of the relatives, occupational contacts and friendship contacts (44-58%) were disclosed within 15 days of treatment initiation. Incremental disclosures made during the 150-180 days of treatment were highest among neighbourhood contacts (12%), and was significantly different between treatment initiation and completion period. Middle aged TB patients (31 years and 46-55 years) were found less likely to disclose (AOR 0.56 and 0.46 respectively; p<0.05) and illiterates were found more likely to disclose their TB status (AOR 3.91; p<0.05). Post the disclosure, family contacts have mostly provided resource support (44.90%) and two third of all disclosed contacts have provided emotional support for TB patients (>71%).

CONCLUSION

Findings explain that family level disclosures were predominant and disclosures made to extra familial network contacts significantly increased during the latter part of treatment. Emotional support was predominantly received by TB patients from all their contacts post disclosure. Findings could inform in developing interventions to facilitate disclosure of disease status in a beneficial way for TB patients.

Satisfaction of Tuberculosis Patients with Directly Observed Treatment Strategy under Pakistan Health Care Policy: A Mixed-Method Study

(1) Background: Patients' satisfaction is based on the perceived health care services of individuals and is influenced by the level of care provided by the health care system. It is often based on the patients' expectations of care and self-assessment of their experiences. The success of the Directly Observed Treatment Strategy (DOTS) also depends on the quality of health care provided at the Tuberculosis (TB) centers, which can be evaluated by satisfaction levels of the patients. (2) Methods: A tuberculosis facility-based cross-sectional study was carried out in Khyber Pakhtunkhwa province in Pakistan. A mixed-method approach was adopted for data collection. An interviewer-administered questionnaire was used for quantitative data collection from 269 patients who were registered at 11 TB centers and private clinics. Qualitative data were collected through 20 in-depth interviews, 15 key informant interviews, and a focus-group discussion. Binary logistic regression was employed for analysis of the data. (3) Results: More than half of the respondents (63.94%) were satisfied with the DOTS strategy. A high percentage of patients were dissatisfied with the availability of safe water, waiting space for patients, waiting time, privacy, and the processing of appointments. Results from the binary logistic regression showed that gender (AOR = 2.21, CI 1.07-4.58, p = 0.033), marital status (AOR = 3.12, CI 1.45-6.73, p = 0.004), employment status (AOR = 5.22, CI 2.44-1.21, p = 0.000), home ownership (AOR = 3.82, CI 1.94-7.54, p = 0.000), literacy (AOR = 2.17, CI 1.11-4.25, p = 0.023), households' main occupation (AOR = 4.42, CI 1.12-17.38, p = 0.033), and level of income (AOR = 2.39, CI 1.13-5.04, p = 0.023) were the significant factors affecting satisfaction levels of the patients. (4) Conclusion: There are a number of areas that need improvement for successful TB eradication. Significant work is required to improve the quality of TB care in these specific areas from the patients' perspective. For instance, female health workers' involvement in the DOTS program can solve the problems of female respondents in rural areas. Improving the infrastructure facilities at the TB centers, allocation of doctors and nurses at the rural health centers would result in positive outcomes of the DOTS in Pakistan as well as in other developing countries.

Pre-Diagnosis Health Seeking Behaviors and Experiences Post-Diagnosis, among Men Diagnosed with Tuberculosis in a District of Gauteng Metropolitan City, South Africa: In-Depth Interviews

BACKGROUND

Tuberculosis remains the number one killer among infectious diseases in South Africa. The TB disease burden is said to be higher among males, 1.6 times more than females in 2018. Moreover, men are reported to have poor healthcare-seeking behaviors. Loss in social and physical functioning, including reduced sexual desires and changes in family life, have been reported following a TB diagnosis. This study explored the meaning that male TB patients attach to their TB diagnosis and impact of TB infection in their lives and those of the people living with them.

METHODS

This exploratory qualitative study was conducted among 25 participants recruited among male patients seeking TB care from two clinics in informal settlements of the city of Johannesburg. In-depth interviews with open-ended questions were conducted using an audio recorder for the collection of data. Data analysis was conducted on the NVivo version 12 software following an inductive thematic approach.

RESULTS

The ages of the participants ranged between 18 and 61 years. Most were unemployed, and only a few were married or in steady relationships. From the two emerging themes, pre-TB diagnosis health-seeking behaviors and post TB-diagnosis experiences, several subthemes were identified. For the former theme, the subthemes include, seeking help from community-based healers and self-medicating, waiting for some period to see if the alternative medicine or treatment worked, taking time to visit a healthcare facility, triggers to seek healthcare, and symptoms reported on presentation to the healthcare facility. The post-TB diagnosis subthemes include making sense of the TB diagnosis, context of disclosing the TB status, fear of social exclusion and experiences of stigma, support received during illness, life changes after TB infection and diagnosis, and lessons learned from the TB experience and future healthcare-seeking behavior.

CONCLUSION

Secrecy about the TB diagnosis indicates fear of social exclusion, and this could be due to the highly stigmatized nature of TB. Waiting to see if alternative medication worked, delayed the TB diagnosis, with consequent late initiation of the anti-TB treatment. The life changes experienced post-TB diagnosis affect the quality of life of the participants and their families. The study recommends that these issues be addressed as a priority.

The dynamic impacts of environmental-health and MDR-TB diseases and their influence on environmental sustainability at Chinese hospitals

The purpose of this study is to identify at what extent multidrug-resistant tuberculosis (MDR-TB) diseases effect on environmental health issues in selected provinces of Chinese hospitals. In survival analysis approach, this study employs the Cox proportional hazard model (CPM) to incorporate the duration of event, probability of occurrence of an event, and the issue of right censoring. An advantage of using CPM is that one does not need to specify the distribution of baseline hazard H₀ (t) as it considers a common value for all units in population. The results indicate that male and travel expenditures have negative association with the duration of cure. Furthermore, the medical expenditures and the spatial characteristic of time expenditure have positive association with the duration of cure of MDR-TB patients. The inconsistent behavior of males in taking medicines as compared to females and males is also more prone to tuberculosis (TB).

Health-Related Quality of Life of Tuberculosis Patients and the Role of Socioeconomic Factors: A Mixed-Method Study

This study aims to assess tuberculosis (TB) patients' health-related quality of life (HRQoL) and to determine the relationship between HRQoL and the socioeconomic and health characteristics of patients. A mixed-method approach of explanatory sequential design is used in this study. Data were collected at 11 TB centers and two private clinics in Khyber Pakhtunkhwa, Pakistan. Quantitative data were collected through a standardized questionnaire (SF-36) of RAND organization from 269 pulmonary TB patients. Qualitative data were collected through 20 in-depth interviews, 15 Key Informant interviews, and a focus group discussion. The maximum score of SF-36 is 100, however, different aspects of HRQoL indicated that patients scored lowest in the role limitation physical (10.3) and emotional (11.2) categories, while the highest remained in the mental health (45.3) category. Patients of higher age, being female, low household income, and comorbidity decreased the HRQoL. Qualitative findings show that TB affected the patients' social functioning, vitality, and emotions. Moreover, poverty and low income, people living in Kacha Houses, family support, and the hate from family members and community are related to low HRQoL. In summary, TB has affected the Patients' HRQoL. TB program managers should pay attention to the nonmedication aspects of TB management. Financial support should be extended TB patients. This study calls for the urgent attention of the National Tuberculosis Program and policymakers, for an increased focus on patients' welfare programs.

A cohort study analyzing the impact of socioeconomic and spatial characteristics alongside treatment regimens on the environmental-health outcomes of the MDR-TB treatment in Pakistan

This study identifies and analyzes a number of factors that correlate with the environmental-health outcome of multi-drug resistance tuberculosis (MDR-TB) treatment in Pakistan. Survival analysis is carried out by applying the multivariable Cox Proportional Hazard model on secondary data of 369 patients registered at three main MDR-TB sites in Pakistan during 2012-2017. Results show that there is no difference in survival of patients between the two treatment arms, hospital and ambulatory care. Male gender and travel expenditure are found to be negatively associated with the environmental-health outcome, whereas spatial characteristic of time expenditure is positively related to it supporting distance bias approach. Medical expenditure is also positively related to the environmental-health outcome. The study concludes that availability of affordable and accessible health services, better environmental conditions, and ambulatory care based on WHO recommendation as well as health education along with social protection schemes should be ensured by the government to improve environmental-health outcome in the resource-scarce setting in Pakistan.