Abstract
Background Global tuberculosis policy increasingly emphasises broad tuberculosis impacts and highlights the lack of evidence concerning tuberculosis-related quality of life (QOL).
Methods Participants were recruited in 32 Peruvian communities between July 13, 2016 and February 24, 2018 and followed-up until November 8, 2019. Inclusion criteria were age ≥15 years for “patients” (n=1545) starting treatment for tuberculosis disease in health centres; “contacts” (n=3180) who shared a patient's household for ≥6 h·week−1; and randomly selected “controls” (n=277). The EUROHIS-QOL questionnaire quantified satisfaction with QOL, health, energy, activities of daily living (ADL), self, relationships, money and living place.
Findings Newly diagnosed tuberculosis was most strongly associated with lower QOL scores (p<0.001). Patients initially had lower QOL than controls for all EUROHIS-QOL questions (p≤0.01), especially concerning health, ADL and self. Lower initial QOL in patients predicted adverse treatment outcomes and scores <13 points had 4.2-fold (95% CI 2.3–7.6) increased risk of death versus those with higher QOL scores (both p<0.001). Patient QOL was re-assessed 6 months later, and for patients with successful treatment QOL became similar to participants who had never had tuberculosis, whereas patients who did not complete treatment continued to have low QOL (p<0.001). Multidrug-resistant tuberculosis was associated with lower QOL before and during treatment (both p<0.001). Contacts had lower QOL if they lived with a patient who had low QOL score (p<0.0001) or were a caregiver for the patient (p<0.001).
Conclusions Tuberculosis was associated with impaired psychosocioeconomic QOL which recovered with successful treatment. Low QOL scores predicted adverse treatment outcome. This brief EUROHIS-QOL eight-item questionnaire quantified the holistic needs of tuberculosis-affected people, potentially guiding patient-centred care.
Abstract
The brief EUROHIS quality-of-life questionnaire can be applied to assist in providing holistic, personalised care to TB-affected families, and guide multisystem interventions required to improve their wellbeing and TB treatment outcome https://bit.ly/2VhDKFM
Footnotes
This article has supplementary material available from erj.ersjournals.com
This article has an editorial commentary: https://doi.org/10.1183/13993003.01998-2020
Conflict of interest: S. Datta has nothing to disclose.
Conflict of interest: R.H. Gilman has nothing to disclose.
Conflict of interest: R. Montoya has nothing to disclose.
Conflict of interest: L. Quevedo Cruz has nothing to disclose.
Conflict of interest: T. Valencia has nothing to disclose.
Conflict of interest: D. Huff has nothing to disclose.
Conflict of interest: M.J. Saunders has nothing to disclose.
Conflict of interest: C.A. Evans has nothing to disclose.
Support statement: This research was funded by The Wellcome Trust (awards 105788/Z/14/Z, 057434/Z/99/Z and 070005/Z/02/Z, 078340/Z/05/Z, 201251/Z/16/Z); DFID-CSCF; the Joint Global Health Trials consortium (Medical Research Council, UK Department for International Development and Wellcome Trust award MR/K007467/1); Imperial College National Institutes of Health Research Biomedical Research Centre; the STOP TB partnership's TB REACH initiative funded by the Government of Canada and the Bill & Melinda Gates Foundation (awards W5_PER_CDT1_PRISMA and OPP1118545); and the charity IFHAD: Innovation for Health and Development. The study funders had no role in data collection, interpretation or writing of this report. The corresponding author had full access to all study data and was responsible for the decision to publish. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received March 8, 2019.
- Accepted April 13, 2020.
- Copyright ©ERS 2020
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