Mahalingam Vasantha, Malaisamy Muniyandi, Daniel Bella Devaleenal, Bhaskar Adhin, Jayabal Lavanya, Murali Lakshmi, Palani Bharadhidasan, Mathiyazhagan Kavi, Yadla Sai Madhu, Srinivasan Padmanaban, Chinnaiyan Ponnuraja
Department of Statistics, ICMR-National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India.
Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India.
PLoS One. 2025 Jul 23;20(7):e0328484. doi: 10.1371/journal.pone.0328484. eCollection 2025.
In India, there is no information on health related quality of life (HRQoL) of patients with drug sensitive tuberculosis (TB) using a longitudinal design that includes post- treatment period. This study is the first of its kind in India to assess HRQoL of TB patients from a longitudinal prospective and to identify the factors associated with changes in HRQoL.
The study participants were 180 newly diagnosed drug-sensitive smear-positive pulmonary TB patients who were initiated on treatment under the National TB Elimination Programme (NTEP) in Chennai and Tiruvallur districts of Tamil Nadu, South India. The patients were interviewed at four different time points between 2020 and 2023 using validated questionnaires assessing general health (European Quality of Life-5 Dimensions-5 Level (EQ-5D-5L), Short Form health survey (SF-20)), disease specific (St. George's Respiratory Questionnaire (SGRQ)) and mental health including depression and anxiety (Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7)). The Friedman test was used to identify changes in HRQoL scores over time and generalised estimating equation (GEE) were applied to identify factors associated with HRQoL.
HRQoL scores of TB patients, as measured by different scales showed significant improvement from treatment initiation to treatment completion. The GEE analysis showed that the EQ-5D-5L scores over follow-up visits were significantly lower in females (-0.038, p < 0.005) and higher in those who did not skip their main meal in a day (0.077, p < 0.001). The PHQ-9 and GAD-7 scores were significantly higher among females (0.609, p < 0.05; 0.531, p < 0.05). Additionally, PHQ-9 scores were also higher among patients from rural district (0.392, p < 0.05). The SF-20 scores were significantly lower in patients aged >45 years (-1.675, p < 0.05), female (-3.809, p < 0.001) and unemployed (-2.277, p < 0.005). The SGRQ scores were higher in patients aged >45 years (3.043, p < 0.01), females (4.256, p < 0.05) and those from rural district (2.219, p < 0.05). The HRQoL scores were significantly higher in patients who did not skip their main meal and lower in females irrespective of the scales used.
The HRQoL of TB patients improved significantly over a period of treatment. Gender, age, skipping main meals, region and employment status were the key factors influencing HRQoL. Focusing on HRQoL assessment in the care of TB patients could help to minimize physical, mental and social challenges and enable them to lead a normal life.
在印度，尚无关于采用包含治疗后阶段的纵向设计来研究药物敏感性肺结核（TB）患者健康相关生活质量（HRQoL）的信息。本研究是印度首例从纵向前瞻性角度评估结核病患者HRQoL并确定与HRQoL变化相关因素的研究。
研究参与者为180名新诊断的药物敏感性涂片阳性肺结核患者，他们在印度南部泰米尔纳德邦金奈和蒂鲁瓦勒尔地区的国家结核病消除计划（NTEP）下开始接受治疗。在2020年至2023年期间的四个不同时间点，使用经过验证的问卷对患者进行访谈，这些问卷评估一般健康状况（欧洲生活质量五维度五水平量表（EQ-5D-5L）、简易健康调查问卷（SF-20））、疾病特异性（圣乔治呼吸问卷（SGRQ））以及包括抑郁和焦虑在内的心理健康状况（患者健康问卷（PHQ-9）、广泛性焦虑障碍量表（GAD-7））。采用弗里德曼检验来确定HRQoL分数随时间的变化，并应用广义估计方程（GEE）来确定与HRQoL相关的因素。
通过不同量表测量，结核病患者的HRQoL分数从治疗开始到治疗结束有显著改善。GEE分析表明，随访期间女性的EQ-5D-5L分数显著较低（-0.038，p<0.005），而一天中未错过主餐的患者分数较高（0.077，p<0.001）。女性的PHQ-9和GAD-7分数显著更高（0.609，p<0.05；0.531，p<0.05）。此外，农村地区患者的PHQ-9分数也更高（0.392，p<0.05）。年龄>45岁的患者（-1.675，p<0.05）、女性（-3.809，p<0.001）和失业患者（-2.277，p<0.005）的SF-20分数显著较低。年龄>45岁的患者（3.043，p<0.01）、女性（4.256，p<0.05）和农村地区患者（2.219，p<0.05）的SGRQ分数更高。无论使用何种量表，未错过主餐的患者HRQoL分数显著更高，而女性分数更低。
结核病患者的HRQoL在治疗期间有显著改善。性别、年龄、错过主餐情况、地区和就业状况是影响HRQoL的关键因素。在结核病患者护理中关注HRQoL评估有助于将身体、心理和社会挑战降至最低，并使他们能够过上正常生活。
