Post-tuberculosis: Sequelae and their Impact on Quality of Life in sub-Saharan Africa
Study design
A multicenter study with a descriptive and analytical aim
Context
There is still limited information on the mid-long-term burden of post-tuberculosis lung disease (PTLD) and its effect on quality of life. The Post-TB SIQ study (ANRS405s), assessed the medium- long-term burden and health-related quality of life (HRQoL) in sub-Saharan Africa.
Our role
Study site
Partners
- ANRS
Methods
Former clinical trial adults (≥18years) in Benin, Guinea and Uganda were contacted 2-20 years after TB cure and invited for a comprehensive evaluation for PTLD. We conducted clinical assessment, spirometry, six-minute walk test, chest X-ray, and administered the St George Respiratory Questionnaire (SGRQ) and the 36-item Short Form Health Survey (SF-36) for HRQoL assessment. A chest high resolution computed tomography (CT) scan was done for participants with clinical suspicion of bronchiectasis. We used the consensus definition of PTLD (according to GLI 2022 standards): presence of pulmonary functional impairment on spirometry and/or the presence of symptomatic bronchiectasis. Characteristics between PTLD and non-PTLD were compared using Chi-squared, Wilcoxon rank sum or Fisher's exact tests depending of the type of variable.
Results
A total of 600 participants were included. The median delay between TB cure to evaluation were 11.1 years, 204 (35%) participants were living with HIV and 72 (12%) presented a dyspnea scale 2. Of the 551 participants that underwent spirometry, the patterns were: 45% (250/551) normal, 21% (118/551) obstruction, 25% (138/551) restriction and 8% (45/551) mixed. Symptomatic bronchiectasis was diagnosed in 14% (84/598) participants. The proportion of PTLD was 57% (339/600). PTLD patients were more likely to have lower BMI, recent history of hemoptysis, poorer exercise tolerance, higher proportion of cough and abnormal chest X-ray, and poor HRQol (Table). About 34% (116/339) with PTLD had FEV1< - 2.5 zscore.
Conclusion
PTLD, 2-20 years after TB treatment is highly common in sub-Saharan Africa. A poor HRQoL in people with past-TB treatment history is more prominent among those with PTLD.PTLD.
