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Association between Health-Related Quality of Life and Medication Adherence in Pulmonary Tuberculosis in South Africa.

  • Kastien-Hilka T Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Basel, Switzerland.
  • Rosenkranz B Division of Clinical Pharmacology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
  • Schwenkglenks M Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.
  • Bennett BM Patient Centered Outcomes, Adelphi Values, Bollington, United Kingdom.
  • Sinanovic E Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
  • 2018-01-13
Published in:
  • Frontiers in pharmacology. - 2017
longitudinal study
medication adherence
patient-reported outcomes
pulmonary tuberculosis
quality of life
English Background: Health-related quality of life (HRQOL) and adherence to treatment are two often inter-related concepts that have implications for patient management and care. Tuberculosis (TB) and its treatment present a major public health concern in South Africa. The study aimed to evaluate the association between HRQOL and adherence in TB patients in South Africa. Methods: Four self-reported HRQOL and one self-reported adherence measures were used in an observational longitudinal multicentre study during 6-month standard TB treatment. These included the generic Short-Form 12 items (SF-12) and European Quality of Life 5 dimensions 5 levels (EQ-5D-5L), the disease-specific St. George's Respiratory Questionnaire (SGRQ) and the condition-specific Hospital Anxiety and Depression Scale (HADS) for HRQOL. Adherence was measured by the Morisky Medication Adherence Scale 8 items (MMAS-8). The relationship between both concepts was examined in 131 patients using Spearman's rho correlations, and linear regression models. Results: HRQOL improved over 6-month TB treatment, whereas adherence mean scores stayed constant with participants attaining a medium average level. Around 76% of patients reported to be high adherers and 24% were reporting a medium or low adherence. Associations between HRQOL and adherence were mainly weak. High adherence at treatment start was positively related to improvements in anxiety and depression after 6-month treatment. The overall improvement in pain and discomfort, and psychosocial health aspects over treatment time was positively, but weakly associated with adherence at 6 months of treatment. Conclusion: A positive relationship exists between adherence and HRQOL in TB in a South African setting, but this relationship was very weak, most likely because HRQOL is affected by a number of different factors and not limited to effects of adherence. Therefore, management of TB patients should, besides adequate drug treatment, address the specific mental and psychosocial needs.
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  • English
Open access status
gold
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https://sonar.ch/global/documents/93398
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