Kastien-Hilka Tanja, Abulfathi Ahmed, Rosenkranz Bernd, Bennett Bryan, Schwenkglenks Matthias, Sinanovic Edina
Swiss Tropical and Public Health Institute (Swiss TPH), Socinstr. 57, 4051, Basel, Switzerland.
University of Basel, Basel, Switzerland.
Health Qual Life Outcomes. 2016 Mar 11;14:42. doi: 10.1186/s12955-016-0442-6.
Tuberculosis (TB) is a leading cause of morbidity and mortality in South Africa. Clinical parameters are important objective outcomes in TB; however they often are not directly correlated with subjective well-being of the patient, but can be assessed using patient-reported outcome (PRO) measures. Health-related quality of life (HRQOL) is a specific PRO generally multi-dimensional in nature and includes physical, mental and social health domains. The inclusion of HRQOL PROs in trials and clinical practice can provide additional information beyondclinical and microbiological parameters. Furthermore, HRQOL may be associated with medication adherence. This review focuses on patient-reported HRQOL and its association with medication adherence in TB patients in South Africa.
A comprehensive search strategy was developed focusing on the impact of TB on patient-reported HRQOL,the existence of a conceptual framework of TB-specific HRQOL, determinants of medication adherence and the association of HRQOL with medication adherence. Data were extracted from all identified articles and additionaldata extraction was performed by two independent reviewers with special focus on longitudinal studies in order to understand changes of HRQOL and adherence over time. Research gaps were identified with regard to patient-reported HRQOL and medication adherence.
A total of 66 articles met the eligibility criteria. Ten HRQOL studies and one adherence study used a longitudinal design, none of these in South Africa. A variety of different generic and disease-specific HRQOL measures were identified in the articles. In South Africa four HRQOL and five adherence studies (non-longitudinal) were published. Similar factors (socio-demographic, socio-economic, disease-related, therapy-related and psycho-social aspects) affect HRQOL and adherence. Although standard TB treatment improved all health domains, psychological well-being and social functioning remained impaired in microbiologically cured patients after treatment.
While evidence of TB impact on HRQOL and medication adherence and their association exists, it is verylimited for the South African situation. No valid and reliable TB-specific HRQOL measures were identified in this systematicreview. An assessment of HRQOL in TB patients in South Africa is required as this may assist with improving current disease management programmes, medication adherence and national treatment guidelines.
结核病是南非发病和死亡的主要原因。临床参数是结核病重要的客观结果；然而，它们往往与患者的主观幸福感没有直接关联，但可以使用患者报告结局（PRO）测量方法进行评估。健康相关生活质量（HRQOL）是一种特定的PRO，通常具有多维度性质，包括身体、心理和社会健康领域。在试验和临床实践中纳入HRQOL PRO可以提供超出临床和微生物学参数的额外信息。此外，HRQOL可能与药物依从性相关。本综述重点关注南非结核病患者报告的HRQOL及其与药物依从性的关联。
制定了一项全面的检索策略，重点关注结核病对患者报告的HRQOL的影响、特定于结核病的HRQOL概念框架的存在、药物依从性的决定因素以及HRQOL与药物依从性的关联。从所有已识别的文章中提取数据，并由两名独立评审员进行额外的数据提取，特别关注纵向研究，以了解HRQOL和依从性随时间的变化。确定了关于患者报告的HRQOL和药物依从性的研究空白。
共有66篇文章符合纳入标准。十项HRQOL研究和一项依从性研究采用了纵向设计，均未在南非进行。文章中确定了各种不同的通用和特定疾病的HRQOL测量方法。在南非，发表了四项HRQOL研究和五项依从性研究（非纵向）。相似的因素（社会人口统计学、社会经济、疾病相关治疗相关和心理社会方面）影响HRQOL和依从性。虽然标准的结核病治疗改善了所有健康领域，但在治疗后微生物学治愈的患者中，心理健康和社会功能仍然受损。
虽然有证据表明结核病对HRQOL和药物依从性及其关联有影响，但针对南非情况的证据非常有限。在本系统评价中未识别出有效且可靠的特定于结核病的HRQOL测量方法。需要对南非结核病患者的HRQOL进行评估，因为这可能有助于改进当前的疾病管理计划、药物依从性和国家治疗指南。
