Determinants of health related quality of life in smear positive and smear negative adult tuberculosis patients in Kampala, Uganda

Abstract

Introduction/background: Smear negative Tuberculosis has been on the rise since the HIV epidemic and is associated with poor clinical outcomes. There is limited information regarding health related quality of life(HRQoL) among in patients with smear negative Tuberculosis compared to those who have smear positive TB. Objective: To compare HRQoL scores in smear positive and smear negative TB patients and determine predictors of quality of life in TB patients using the WHO_BREF tool. Methodology: This was a cross sectional study among 216 TB patients. Client exit interviews were conducted. We used paired t-tests to analyze differences in mean scores, stratifying by disease category and HIV status. Multiple linear regression models were used to establish factors associated with HRQoL. Results: Of the 208 participants, 56.2% were males, 51.4% were TB smear negative. Smear negative TB patients had mean (SD) scores that were significantly lower in environment health compared to smear positive patients; 52.04(14.86) versus 56.49 (13.57); p= 0.025. TB-HIV co infected patients recorded lower mean (SD) scores in social relationships and environment health compared to those who only had TB; [61.26(21.8) versus 67.4 (17.69); p = 0.028)] and 50.7(13.7) versus;(57.8(13.7) p=0.0003 respectively. Having moderate to severe Depression was associated with all health domains; physical (-17.43 (95% (CI;-23.08, -11.50)), social relationships (-14.76 (95%CI;-25.64, -9.73)), environment (-10.96 (95%CI-16.63,-3.92)) and Psychological (-16.86 (95% CI; -22.83, -10.90). Other predictors of HRQoL in different health domains were; stigma (-5.33 (95% CI:-10.29, -0.37)), continuation phase of treatment (6.32 13 (95%CI; 1.72, 10.92)), satisfaction with the social support; (4.39(95% CI; 0.85, 7.94)), secondary education and above (6.38(95%CI; 1.86, 9.54)), and gender (4.37(95% CI; 1.68, 8.51). Conclusion: Smear negative TB patients have lower scores of health quality of life in environment health compared to smear positive patients. Health related quality of life in TB patients is associated with depression, continuation phase of treatment, being female, having received secondary education and above and, stigma.