The health-related quality of life of drug-resistant tuberculosis patients receiving treatment in Botswana

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BACKGROUND: Drug-resistant tuberculosis (DR-TB) poses a significant global health challenge and requires treatment with potentially toxic second-line anti-TB drugs. Assessing the health-related quality of life (HRQoL) of DR-TB patients is crucial, given the impact of disease and treatment on their well-being. This study aimed to evaluate HRQoL among DR-TB patients undergoing treatment in Botswana and identify predictors of variability during the treatment period. METHODS: A cross-sectional study involving almost all the eligible clients in the DR-TB treatment database was conducted at four of the six DR-TB sites in Botswana. The SF-36v2-based questionnaire was administered to all patients receiving treatment between March 2022 and June 2023. Data analysis was performed with QualityMetric Inc., LLC PRO CoRE scoring software and Stata 13.1 for the HRQoL scoring and regression analyses, respectively. A score ≤ 47 on the norm-based scoring (NBS) indicated poor HRQoL. Shorter, all-oral DR-TB regimens were introduced since 2018 but Botswana had not yet fully implemented those in the years 2022/2023. Patients had to go on treatment for 18-24 months during the time of the study. RESULTS: Seventy-two of the 81 eligible participants were enrolled. Participants on treatment for 13-24 months exhibited better HRQoL scores (53.3 ± 8.4) than those in the initial (0-12 months, 46.9 ± 10.8) and latter phases of treatment (> 24 months, 44.3 ± 10.1) for the Physical Component Summary (PCS) even though it was not statistically significant (p = 0.0996). The mental component summary (MCS) scores were 41.6 ± 11.3, 51.6 ± 7.8, and 41.3 ± 10.7 for 0-12, 13-24, and > 24 months, respectively, with significant differences observed for the MCS (p = 0.0097). Multivariate analysis identified renal impairment as a predictor of PCS variability, while alcohol consumption, prior TB treatment, and lung cavity on chest X-ray imaging predicted MCS variability. CONCLUSION: DR-TB patients in Botswana demonstrated comparable or improved HRQoL (> 47 NBS) in their second year (13-24 months) of treatment, contrasting with poorer HRQoL scores in the initial and final years for both the PCS and MCS. The findings underscore the necessity for tailored psychosocial support, advocated for its integration into the Botswana National TB Program as a pilot initiative before widespread implementation.

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