Effects of Multidrug Resistant Tuberculosis Treatment on Patients' Health Related Quality of Life: Results from a Follow Up Study

Abstract

Background: At present, within the management of multidrug resistant tuberculosis (MDR-TB) much attention is being paid to the traditional microbiological and clinical indicators. Evaluation of the impact of MDR-TB treatment on patients' Health Related Quality of Life (HRQoL) has remained a neglected area.

Objective: To evaluate the impact of MDR-TB treatment on patients HRQoL, and determine the predictors of variability in HRQoL along the course of treatment.

Methods: A prospective follow up study was conducted at the programmatic management unit for drug resistant TB of Lady Reading Hospital Peshawar. Culture confirmed eligible MDR-TB patients were asked to self complete SF-36v2 at the baseline visit, and subsequently after the completion of 12 months of treatment and at the end of treatment. A score of <47 norm-based scoring (NBS) points on component summary measures and health domain scales was considered indicative of function impairment. General linear model repeated measures ANOVA was used examine the change and predictors of change in physical component summary (PCS) and mental component summary (MCS) scores over the time.

Results: A total of 68 out of enrolled 81 eligible MDR-TB patients completed SF-36v2 questionnaire at the three time points. Patients' mean PCS scores at the three time points were, 38.2±4.7, 38.6±4.4 and 42.2±5.2 respectively, and mean MCS were 33.7±7.0, 35.5±6.9 and 40.0±6.9 respectively. Length of sickness prior to the diagnosis of MDR-TB was predictive of difference in PCS scores (F = 4.988, Df = 1, 66), whereas patients' gender (F = 5.638, Df = 1, 66) and length of sickness prior to the diagnosis of MDR-TB (F = 4.400, Df = 1, 66) were predictive of difference in MCS scores.

Conclusion: Despite the positive impact of MDR-TB treatment on patients' HRQoL, the scores on component summary measures suggested compromised physical and mental health even at the end of treatment. A large multicenter study is suggested to confirm the present findings.

Fig 1. Flow diagram of patients screened, included and evaluated for impact of MDR-TB treatment on patients’ HRQoL.

Fig 2. Patient’ gender: difference in the estimated marginal means of MCS scores.

Fig 3. Marital status: difference in the estimated marginal means of MCS scores.

Fig 4. Length of sickness for ≥ 1 year prior to the diagnosis of MDR-TB: difference in the estimated marginal means of PCS scores.

Fig 5. Length of sickness for ≥1 year prior to the diagnosis of MDR-TB: difference in the estimated marginal means of MCS scores.