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Margineanu I, Butnaru T, Lam M, Baiceanu D, Dragomir R, Arbore AS, Mahler B, Munteanu I, Mihaltan F, Akkerman O, Alffenaar JW, Stienstra Y. 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. Trop Med Int Health 2024; 29:584-593. [PMID: 38794852 DOI: 10.1111/tmi.13996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
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.
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Affiliation(s)
- Ioana Margineanu
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centrum Groningen, Groningen, the Netherlands
| | - Teodora Butnaru
- Department of Respiratory Medicine, Marius Nasta Tb Institute, Bucharest, Romania
| | - Marjolein Lam
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Dragos Baiceanu
- Department of Respiratory Medicine, Marius Nasta Tb Institute, Bucharest, Romania
| | - Raluca Dragomir
- Department of Respiratory Medicine, Marius Nasta Tb Institute, Bucharest, Romania
| | | | - Beatrice Mahler
- Department of Respiratory Medicine, Marius Nasta Tb Institute, Bucharest, Romania
| | - Ioana Munteanu
- Department of Respiratory Medicine, Marius Nasta Tb Institute, Bucharest, Romania
| | - Florin Mihaltan
- Department of Respiratory Medicine, Marius Nasta Tb Institute, Bucharest, Romania
| | - Onno Akkerman
- Department of Pulmonary diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Tuberculosis Center Beatrixoord, University of Groningen, University Medical Center Groningen, Haren, the Netherlands
| | - Jan-Willem Alffenaar
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centrum Groningen, Groningen, the Netherlands
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Westmead Hospital, Westmead, New South Wales, Australia
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, New South Wales, Australia
| | - Ymkje Stienstra
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Wang H, Gu J, Zhang L, Song Y. Assessing the quality of life in patients with drug-resistant tuberculosis: a cross-sectional study. BMC Pulm Med 2024; 24:303. [PMID: 38937809 PMCID: PMC11210023 DOI: 10.1186/s12890-024-03119-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 06/20/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND This study investigated the current status of the quality of life (QOL) of drug-resistant tuberculosis (DR-TB) patients in Nanjing, China, and analyzed the influencing factors. METHODS The survey was conducted among patients with DR-TB who were hospitalized in the tuberculosis department of the Second Hospital of Nanjing (Nanjing Public Health Medical Center) from July 2022 to May 2023. The Chinese version of the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire was used to investigate the QOL levels of patients with DR-TB, and a multiple linear regression model was used to analyze the QOL influencing factors. RESULTS A total of 135 patients participated in the study; 69.6% were male, the average age was 46.30 ± 17.98 years, 13.33% had an education level of elementary school or below, and 75.56% were married. The QOL scores were 51.35 ± 17.24, 47.04 ± 20.28, 43.89 ± 17.96, and 35.00 ± 11.57 in the physiological, psychological, social, and environmental domains, respectively. The differences between the four domain scores and the Chinese normative results were statistically significant (P < 0.05). The results of multiple linear regression analysis showed that the factors related to the physiological domain included residence, family per-capita monthly income, payment method, adverse drug reactions (ADRs), and comorbidities; psychological domain correlates included educational level, family per-capita monthly income, course of the disease, and caregivers; social domain correlates included age and comorbidities; and factors related to the environmental domain included age, education level, and comorbidities. CONCLUSIONS In Nanjing, China, patients with younger age, higher education level, living in urban areas, high family per-capita monthly income, no adverse drug reactions, no comorbidities, and having caregivers have better quality of life. Future interventions to improve the quality of life of patients with drug-resistant tuberculosis could be tailored to a specific factor.
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Affiliation(s)
- He Wang
- School of Nursing, Nanjing University of Chinese Medicine, No.138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province, P.R. China
| | - Jiayi Gu
- School of Nursing, Nanjing University of Chinese Medicine, No.138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province, P.R. China
| | - Lijun Zhang
- Department of Tuberculosis, The Second Hospital of Nanjing, Affiliated to Nanjing University of Chinese Medicine, No.1 Rehabilitation Road, Tangshan Street, Jiangning District, Nanjing, Jiangsu Province, P.R. China
| | - Yan Song
- Department of Nursing, The Second Hospital of Nanjing, Affiliated to Nanjing University of Chinese Medicine, No.1-1 Zhongfu Road, Gulou District, Nanjing, 210003, Jiangsu, P.R. China.
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Davis RA, Leavitt HB, Singh A, Fanouraki E, Yen RW, Bratches RW. Examining interventions that aim to enhance TB treatment adherence in Southeast Asia: A systematic review and meta-analysis. Indian J Tuberc 2024; 71:48-63. [PMID: 38296391 DOI: 10.1016/j.ijtb.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/10/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Adherence is often a barrier to curative treatment of Mycobacterium tuberculosis (TB). There have been numerous interventions focused on increasing TB treatment adherence in Southeast Asia, but it is unclear if they are effective. This systematic review and meta-analysis aimed to compile and evaluate the literature on interventions designed to increase TB treatment adherence in Southeast Asia. METHODS We searched Cochrane Library Reviews (CDSR) and Cochrane Library Trials (CENTRAL), Medline, CINAHL, Scopus, and Web of Science from 2000 to 2022 with no language restrictions. We included studies of any design conducted in Southeast Asia that implemented interventions to increase treatment completion in people diagnosed with TB and assessed completion as an outcome. We did not require a control group. Four investigators used a standardized data collection form to collate results. The heterogeneity across studies was explored by I2 statistics. We assessed bias using the Newcastle-Ottawa Scale and Cochrane ROB 2.0. We used a random effects meta-analysis to calculate a pooled risk ratio with 95% confidence intervals. RESULTS From 1881 abstracts, we included 14 articles. There were 7198 subjects with 3163 (44%) receiving a TB treatment adherence intervention across eight countries. Interventions included directly observed therapy, text-message reminders, food incentives, and more. The risk ratio, derived from the meta-analysis of eight included studies with a control group and 6618 participants overall, was 1.04 (95% CI 1.01,1.08; I2 = 29%), favoring the interventions over controls with little concern for heterogeneity or risk of bias. When narratively assessed, the other six studies all reported increased adherence in the intervention group. DISCUSSION The results suggested there is a small, statistically significant benefit of using interventions to promote TB treatment completion. Future research could look at additional strategies and combinations of strategies to promote adherence.
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Affiliation(s)
- Rebekah A Davis
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - Hannah B Leavitt
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Aditya Singh
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Eleni Fanouraki
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Renata W Yen
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Reed W Bratches
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Hammouda EA, Gobran WF, Tawfeek RM, Esmail OF, Ashmawy R, Youssef N, Ghazy RM. Survey to measure the quality of life of patients with tuberculosis in Alexandria, Egypt: a cross-sectional study. BMC Health Serv Res 2023; 23:534. [PMID: 37226176 DOI: 10.1186/s12913-023-09381-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/09/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Assessment of quality of life (QoL) in patients with tuberculosis (TB) may improve healthcare providers' understanding of the disease burden. This study aimed to investigate the QoL of patients with TB in Alexandria, Egypt. METHODS This cross-sectional study was conducted in chest clinics and main chest hospitals in Alexandria, Egypt. A structured interview questionnaire was used to collect data from participants through face-to-face interviews from November 20, 2021, until the June 30, 2022. We included all adult patients aged 18 years or above during the intensive or continuation phase of treatment. The World Health Organization (WHO) WHOQOL-BREF instrument was used to measure QoL, which includes the physical, psychological, social relationships, and environmental health domains. Using propensity score matching, a group of TB free population was recruited from the same setting and completed the questionnaire. RESULTS A total of 180 patients participated in the study: 74.4% were males, 54.4% were married, 60.0% were 18-40 years old, 83.3% lived in urban areas, 31.7% were illiterate, 69.5% reported insufficient income, and 10.0% had multidrug-resistant TB. The TB-free population group had higher QoL scores than the TB patients' group: (65.0 ± 17.5 vs. 42.4 ± 17.8) for the physical domain, (59.2 ± 13.6 vs. 41.9 ± 15.1) for the psychological domain, (61.8 ± 19.9 vs. 50.3 ± 20.6) for the social domain, (56.3 ± 19.3 vs. 44.5 ± 12.8) for the environment domain, (4.0(3.0-4.0) vs. 3.0(2.0-4.0)) for general health, and (4.0(3.0-4.0) vs. 2.0(2.0-3.0)) for the general QoL, P < 0.0001. Patients with TB aged 18-30 years had the highest environmental score compared with the other age groups (P = 0.021). CONCLUSIONS TB had a significant negative impact on QoL, with the physical and psychological domains being the most affected. This finding necessitates strategies to improve QoL of patients with to enhance their compliance to treatment.
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Affiliation(s)
- Esraa Abdellatif Hammouda
- Department of Clinical Research, El-Raml pediatric hospital, Ministry of Health and Population, Alexandria, Egypt.
| | - Wahib Fayez Gobran
- Director of Chest Diseases, Ministry of Health and Population, Alexandria, Egypt
| | | | | | - Rasha Ashmawy
- Department of Clinical Research, Maamoura Chest Hospital, Ministry of Health and Population, Alexandria, Egypt
| | - Naglaa Youssef
- Medical-Surgical Nursing Department, Faculty of Nursing, Cairo University, Cairo, Egypt
- Department of Medical-surgical Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Ramy Mohamed Ghazy
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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Tornu E, Quarcoopome L. Correlates of quality of life among persons living with tuberculosis: A cross-sectional study. PLoS One 2022; 17:e0277192. [PMID: 36331938 PMCID: PMC9635747 DOI: 10.1371/journal.pone.0277192] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction The correlates of quality of life originating from the demographic characteristics, comorbidities and sources of social support among persons living with tuberculosis remain underreported. The aim of this study was to examine the correlates of quality of life among persons living with tuberculosis within Greater Accra, Ghana. Methods A cross-sectional survey design was used to assess the correlates of quality of life among 250 randomly sampled persons living with tuberculosis. Quality of life was assessed with the Quality of Life Brief Version (WHOQOL-BREF) questionnaire and correlates were derived using Spearman rho correlations. Chi-square analyses assessed associations among respondent characteristics. Results All four quality of life domains (physical, psychological, social relationship and environmental) of persons living with tuberculosis were positively correlated. Furthermore, receiving social support from family or friends correlated positively with respondents’ quality of life. Human Immunodeficiency Virus (HIV) infection and receiving social support mainly from work colleagues or religious institutions correlated negatively with respondents’ quality of life domains. Other correlates of quality of life included age, pleuritis with pleural effusion, number of dependants and distance to tuberculosis treatment centres. Social support from family and friends corresponded with better quality of life among persons living with tuberculosis. Conclusion The quality of life domains of persons living with tuberculosis are interrelated and can be enhanced by social support. Healthcare providers should involve the significant others of persons living with tuberculosis, human immunodeficiency virus and pleuritis with pleural effusion in their care to promote patients’ quality of life.
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Affiliation(s)
- Eric Tornu
- Department of Adult Health, School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Louisa Quarcoopome
- Department of Internal Medicine and Therapeutics, Korle-Bu Teaching Hospital, Korle-Bu, Accra, Ghana
- * E-mail:
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Manyazewal T, Woldeamanuel Y, Fekadu A, Holland DP, Marconi VC. Effect of Digital Medication Event Reminder and Monitor-Observed Therapy vs Standard Directly Observed Therapy on Health-Related Quality of Life and Catastrophic Costs in Patients With Tuberculosis: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2230509. [PMID: 36107429 PMCID: PMC9478770 DOI: 10.1001/jamanetworkopen.2022.30509] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/22/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Little is known about whether digital adherence technologies are economical for patients with tuberculosis (TB) in resource-constrained settings. Objective To test the hypothesis that for patients with TB, a digital medication event reminder monitor (MERM)-observed therapy provides higher health-related quality of life (HRQoL) and lower catastrophic costs compared with standard directly observed therapy (DOT). Design, Setting, and Participants This study was a secondary analysis of a randomized, 2-arm, open-label trial conducted in 10 health care facilities in Ethiopia. Eligible participants were adults with new or previously treated, bacteriologically confirmed, drug-sensitive pulmonary TB who were eligible to start first-line anti-TB therapy. Participants were enrolled between June 2, 2020, and June 15, 2021, with the last participant completing follow-up on August 15, 2021. Interventions Participants were randomly assigned (1:1) to receive a 15-day TB medication supply dispensed with a MERM device to self-administer and return every 15 days (intervention arm) or the standard in-person DOT (control arm). Both groups were observed throughout the standard 2-month intensive treatment phase. Main Outcomes and Measures Prespecified secondary end points of the original trial were HRQoL using the EuroQoL 5-dimension 5-level (EQ-5D-5L) tool and catastrophic costs, direct (out-of-pocket) and indirect (guardian and coping) costs from the individual patient perspective using the World Health Organization's Tool to Estimate Patient Costs, and common factors associated with lower HRQoL and higher catastrophic costs. Results Among 337 patients screened for eligibility, 114 were randomly assigned, and 109 were included in the final complete-case intention-to-treat analysis (57 control and 52 intervention participants). The mean (SD) age was 33.1 (11.1) years; 72 participants (66.1%) were men, and 15 (13.9%) had HIV coinfection. EQ-5D-5L overall median (IQR) index value was 0.964 (0.907-1). The median (IQR) value was significantly higher in intervention (1 [0.974-1]) vs control (.908 [0.891-0.964]) (P < .001). EQ-5D-5L minimum and maximum health state utility values in intervention were 0.906 and 1 vs 0.832 and 1 in control. Patients' overall median (IQR) postdiagnosis cost was Ethiopian birr (ETB) 80 (ETB 16-ETB 480) (US $1.53). The median cost was significantly lower in intervention (ETB 24 [ETB 16-ETB 48]) vs control (ETB 432 [ETB 210-ETB 1980]) (P < .001), with median possible cost savings of ETB 336 (ETB 156-ETB 1339) (US $6.44) vs the control arm. Overall, 42 participants (38.5%; 95% CI, 29.4%-48.3%) faced catastrophic costs, and this was significantly lower in the intervention group (11 participants [21.2%]; 95% CI, 11.1%-34.7%) vs control (31 participants [54.4%]; 95% CI, 40.7%-67.6%) (P < .001). Trial arm was the single most important factor in low HRQoL (adjusted risk ratio [ARR], 1.49; 95% CI, 1.35-1.65; P < .001), while trial arm (ARR, 2.55; 95% CI, 1.58-4.13; P < .001), occupation (ARR, 2.58; 95% CI, 1.68-3.97; P < .001), number of cohabitants (ARR, 0.64; 95% CI, 0.43-0.95; P = .03), and smoking (ARR, 2.71; 95% CI, 1.01-7.28; P = .048) were the most important factors in catastrophic cost. Conclusions and Relevance In patients with TB, MERM-observed therapy was associated with higher HRQoL and lower catastrophic costs compared with standard DOT. Patient-centered digital health technologies could have the potential overcoming structural barriers to anti-TB therapy. Trial Registration ClinicalTrials.gov Identifier: NCT04216420.
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Affiliation(s)
- Tsegahun Manyazewal
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yimtubezinash Woldeamanuel
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - David P. Holland
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, Georgia
| | - Vincent C. Marconi
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, Georgia
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Quarcoopome L, Tornu E. Health-related quality of life of persons living with tuberculosis: A cross-sectional study. J Clin Tuberc Other Mycobact Dis 2022; 28:100324. [PMID: 35813286 PMCID: PMC9260615 DOI: 10.1016/j.jctube.2022.100324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Tuberculosis is a chronic infectious disease that can affect the quality of life of persons living with tuberculosis in resource-limited settings. There is a dearth of research on the quality of life of persons living with tuberculosis within Greater Accra, Ghana. Purpose This study investigated the quality of life and its related factors among persons living with tuberculosis in the Greater Accra region of Ghana. Methods This descriptive cross-sectional survey assessed the physical, psychological, social relationship and environmental quality of life of 250 persons living with tuberculosis in four public health facilities using the World Health Organization's Quality of Life Brief Questionnaire instrument. Results Respondents' mean (standard deviation) physical, psychological, social relationship and environmental health-related quality of life domain scores were 46.19 (21.27), 50.67 (23.95), 40.9 (21.74) and 51.91 (20.13) respectively out of 100. Sociodemographic factors which influenced all four quality of life domains were their marital and employment statuses. Respondents' site of TB infection (pulmonary or extrapulmonary) and phase of treatment influenced their physical, psychological and social domains. Other determinants of the quality of life were their sex, highest level of education and average monthly income. Conclusions The quality of life of persons living with tuberculosis was found to be poor and influenced by the patients' socioeconomic status. Strategies that identify and address any deterioration in the quality of life of persons living with TB are required throughout their management.
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Affiliation(s)
- Louisa Quarcoopome
- Department of Internal Medicine and Therapeutics, Korle-Bu Teaching Hospital, P.O.Box KB 77, Korle-Bu, Accra, Ghana
| | - Eric Tornu
- Department of Adult Health, School of Nursing and Midwifery, College of Health Sciences, University of Ghana, P.O. Box LG 43, Legon, Accra, Ghana
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