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Table 1 Data Extraction of longitudinal studies evaluating HRQOL and adherence in TB

From: Health-related quality of life and its association with medication adherence in active pulmonary tuberculosis– a systematic review of global literature with focus on South Africa

Reference Study Objective Study Setting/Sample Size Population Comparator Group HRQOL Measure Application time pointof HRQOL Measure Overall Outcome in HRQOL Outcomes in HRQOL Domains
Aggarwal et al.2013 [10] To quantify impairment in HRQOL and to evaluate the utility India
N = 1034
Newly diagnosed PTB patients None WHOQOL-BREF
Hindi version
1st time point: within 2 weeks of initiating intensive phase 2nd time point: within 2 weeks of switching to continuation phase 3rd time point: within 2 weeks of stopping treatment Impaired HRQOLimproves significantlywith anti-tuberculosistreatment. Residualimpairment is noticedin some patients at theend of treatment Patients in urban areas and those with higher socioeconomic status (SES) have higher domain scores and better HRQOL. The WHOQOL-BREF physical and psychological domain scores are significantly lower and more affected than other domains.
Atif et al. 2014 [64] To evaluate the impact of TB treatment on HRQOL Malaysia
n = 216
New smear positive PTB patients; no HIV co-infection None SF-36 v2 Tamil, Malay and Mandarin version 1st time point: start of treatment 2nd time point: end of intensive phase 3rd time point: end of treatment Impaired HRQOL improves significantly with anti-tuberculosis treatment. Scores inthe physical and mental health components were still impaired after end of treatment Health domains improve between baseline and end of the intensive phase, and end of treatment, except for bodily pain and vitality. At the start of treatment, 67.1 % of patients are at risk of depression, compared to 35 % at end of intensive phase and 23.5 % at end of treatment. Patients aged <45 years and/or non-smokers have a better mean physical component summary (PCS)score. Lower and affected mental health is related to smoking, low income and presence of more than three TB symptoms.
Balgude et al. 2012 [19] To assess the impact of TB and treatment on HRQOL India
n = 60, (30 patients and 30 controls)
Newly diagnosed smear positive TB patients Healthy control from the general population WHOQOL-BREF plus 2 items examined separately 1st time point: baseline 2nd time point: after 2 months 3rd time point: after 4 months At baseline, HRQOL is significantly affected with physical and psychological domains most affected. All domains improve after 2 and 4 month treatment. Mean scores of patients’ physical and psychological domains are lower than controls at all 3 time points of assessment. There is significant improvement in the scores at 2 & 4 months of treatment. The mean scores of patients’ environmental and social domains are lower than control at baseline, but improve at 4 months of treatment and are comparable to control
Chamla 2004 [29] To assess impact of TB and treatment on HRQOL China
n = 205, (102 patients and 103 controls
TB patients General population without TB SF-36
Chinese version
1st time point: before treatment 2nd time point: after 2 months 3rd time point: end of treatment. HRQOL is impaired at baseline with physical scales most affected and improves due to treatment. Treatment improves all domains; at end of treatment physical functioning, role-emotional, bodily pain, social functioning and general health are not different from control. Physical scales are more commonly affected than mental health scales.
Dhuria et al. 2009 [26] To assess impact of TB and treatment on HRQOL India
n = 180,(n = 90 patients and 90 controls)
TB patients General population matching for age, gender and socioeconomic status WHOQOL-BREF
Hindi version
1st time point: baseline 2nd time point: 3 months 3rd time point: end of treatment. TB patients have an impaired HRQOL with significant improvement in all domains except social domain after treatment. The highest improvement is in physical domain, followed by psychological domain. The mean score of overall HRQOL and physical domain at completion of treatment is better in females than males. Males score better in psychological, social and environmental domains. After end of treatment HRQOL is still affected in physical domains compared to healthy controls.
Kruijshaar et al. 2010 [39] To assess the impact of TB and its treatment on patients’ health status UK
n = 61
TB patients None SF-36 v2
UK version
1st time point: diagnosis 2nd time point: 2 months Impaired HRQOL improves already after 2 month treatment, but is still below the UK norm score SF-36 v2 scores improve significantly except for physical functioning, general health perceptions and physical summary score. Vitality, mental health and mental health summary scores are comparable to the UK norm. EQ-5D: pain/discomfort andproblems with self-care improvewhile a borderline decrease is seen for mobility, except for self-care. Depression and anxiety improveddue to treatment (CES-D andSTAI-6 scores). 51 % report economic burden due to TB.
Maguire et al. 2009 [66] To quantify the impact of TB HRQOL Indonesia
n = 115
smear positive PTB patients None SGRQ 1st time point: baseline 2nd time point: 2 months 3rd time point: 6 months Impaired HRQOL improves with treatment at 2 and 6 months Although HRQOL improves due to treatment 24.6 % of patients still have significant lung function impairment after at end of treatment
Mamani et al. 2014 [65] To assess the QOL among TB patients Iran
n = 184 (64 patients and 120 controls)
Pulmonary and extrapulmonary TB patients Healthy control from general population SF-36
Persian version
1st time point: baseline 2nd time point: 2 months 3rd time point: 6 months Impaired HRQOL improves due to treatment compared to controls All domains of SF-36 aresignificantly impaired andimprove after 2 month treatment; improvement betweentwo and six months is not significant. Physical functioningand energy are most affected.
Marra et al. 2008 [28] To identify areas of HRQOL affected by latent and active TB; treatment impact on HRQOL Canada
n = 206 (104 active TB and 102 latent TB)
Active and latent TB patients (LTBI) LTBI defined as a positive TST result without radiographic or clinical evidence of active TB SF-36 v2
1st time point: baseline 2nd time point: 3 months 3rd time point: 6 months At baseline HRQOL is more affected in active than latent TB patients. Treatment improves HRQOL in active but not in latent TB. Patients with active TB have still impaired HRQOL after treatment completion compared to US norms. All domains of SF-36 improve overtreatment in active and latent TBexcept bodily pain inactive andexcept social functioning andvitality in latent TB.BDI showsnoimprovement in LTBIparticipants, but significant improvement for those with active TB.
Ralph et al. 2013 [17] To investigate morbidity over TB treatment period Indonesia
n = 240, (200 patients and 40 controls)
smear positive TB Healthy control from the general population SGRQ
Indonesian version
1st time point: baseline 2nd time point: 4 weeks 3rd time point: 8 weeks 4th point time: 24 weeks Impaired HRQOL improved over treatment time. After treatment 27 % of TB patients have moderate to severe pulmonary function impairment. HIV -positive status was significantly associated with worse HRQOL
Reference Study Objective Study Setting Population Comparator Group Adherence Measure Application time point of Adherence Measure Overall Outcome in Adherence Specific Outcome in Adherence
Chirwa et al. 2013 [51] To estimate cure rates, and their association with adherence to TB treatment Malawi
n = 524
TB patients None Retrospective counting of missing days during treatment Retrospective review of records Adherence to TB treatment had a significant effect on cure of TB Overall, 35.1 % of patients did not fully adhere to TB treatment. Of these, 86.4 % missed < 15 days and 23.4 % missed at least 1 day of treatment Overall, 92.7 % of patients were cured from TB and 33.7 % of these missed at least 1 day of treatment. Patients who missed <15 days and 15 to 29 days of treatment were less likely to be cured compared with those who fully adhered.
  1. Table 1: data extraction from 11 longitudinal studies evaluating HRQOL (10 studies) and adherence (1 study)
  2. SF-36 short form 36, EQ-5D EuroQol 5 dimensions, SGRQ St. George’s respiratory questionnaire, WHOQOL-BREF World Health Organization Quality of Life Short Form, BDI Beck’s depression index, STAI-6 state-trait anxiety short-form, CES-D Center for Epidemiologic Studies Depression Scale