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Background <p>United Nations Sustainable Development Goal 3 (Target 3.3) calls for ending the tuberculosis (TB) epidemic by 2030; yet TB programmes in low-income settings remain acutely vulnerable to pandemic disruption. During the COVID-19 first wave, TB patients in urban Bangladesh faced a convergence of disease burden, pandemic-related stressors, and poverty-driven resource constraints. Systematic evidence quantifying health-related quality of life (HRQoL) deterioration in this population and identifying its modifiable structural determinants is limited.</p> Methods <p>A convergent parallel mixed-methods study was conducted among 439&#xa0;TB patients attending 12 Directly Observed Treatment, Short-course (DOTS) clinics across six municipal districts in Dhaka, Bangladesh, between August and September 2020. HRQoL was measured with the EQ-5D-3L and post-traumatic stress with the Impact of Event Scale-Revised (IES-R). Multinomial logistic regression identified factors independently associated with HRQoL deterioration. Concurrently, 36 semi-structured in-depth interviews were analysed using Braun and Clarke's thematic analysis framework.</p> Results <p>Pain or discomfort was reported by 46.5% of participants (95% CI: 41.9–51.1%) and anxiety or depression by 36.9% (95% CI: 32.5–41.5%). On multivariable analysis, anxiety/depression was independently associated with larger household size (adjusted OR = 1.08 per person; 95% CI: 1.03–1.14; <i>p</i> = 0.002), greater distance to the DOTS clinic (adjusted OR = 1.03 per km; 95% CI: 1.01–1.05; <i>p</i> &lt; 0.001), and appointment intervals of ≤ 14&#xa0;days versus 15–30&#xa0;days (adjusted OR = 2.86; 95% CI: 1.33–7.14; <i>p</i> = 0.011). Drug-resistant TB was strongly associated with activity limitation (adjusted OR = 27.7; 95% CI: 8.3–92.4). Qualitative analysis identified three themes: stigma intensification through symptom conflation with COVID-19; economic hardship obstructing treatment adherence and nutrition; and perceived inadequacy of government relief for chronically ill populations.</p> Conclusions <p>In this cross-sectional study, HRQoL deterioration among urban TB patients in Bangladesh during the COVID-19 pandemic was significantly associated with modifiable structural factors. These preliminary findings suggest that appointment scheduling optimisation, service decentralisation, nutritional support, and psychosocial services may reduce pandemic-era HRQoL burden. Prospective longitudinal studies are needed to establish causality and inform programme design.</p>

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Health-Related Quality of Life Deterioration Among Tuberculosis Patients During the COVID-19 Pandemic: a Convergent Mixed-Methods Study of Syndemic Vulnerability in Urban Bangladesh

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月25日

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  • Santu Das,
  • Rantu Das

摘要

Background

United Nations Sustainable Development Goal 3 (Target 3.3) calls for ending the tuberculosis (TB) epidemic by 2030; yet TB programmes in low-income settings remain acutely vulnerable to pandemic disruption. During the COVID-19 first wave, TB patients in urban Bangladesh faced a convergence of disease burden, pandemic-related stressors, and poverty-driven resource constraints. Systematic evidence quantifying health-related quality of life (HRQoL) deterioration in this population and identifying its modifiable structural determinants is limited.

Methods

A convergent parallel mixed-methods study was conducted among 439 TB patients attending 12 Directly Observed Treatment, Short-course (DOTS) clinics across six municipal districts in Dhaka, Bangladesh, between August and September 2020. HRQoL was measured with the EQ-5D-3L and post-traumatic stress with the Impact of Event Scale-Revised (IES-R). Multinomial logistic regression identified factors independently associated with HRQoL deterioration. Concurrently, 36 semi-structured in-depth interviews were analysed using Braun and Clarke's thematic analysis framework.

Results

Pain or discomfort was reported by 46.5% of participants (95% CI: 41.9–51.1%) and anxiety or depression by 36.9% (95% CI: 32.5–41.5%). On multivariable analysis, anxiety/depression was independently associated with larger household size (adjusted OR = 1.08 per person; 95% CI: 1.03–1.14; p = 0.002), greater distance to the DOTS clinic (adjusted OR = 1.03 per km; 95% CI: 1.01–1.05; p < 0.001), and appointment intervals of ≤ 14 days versus 15–30 days (adjusted OR = 2.86; 95% CI: 1.33–7.14; p = 0.011). Drug-resistant TB was strongly associated with activity limitation (adjusted OR = 27.7; 95% CI: 8.3–92.4). Qualitative analysis identified three themes: stigma intensification through symptom conflation with COVID-19; economic hardship obstructing treatment adherence and nutrition; and perceived inadequacy of government relief for chronically ill populations.

Conclusions

In this cross-sectional study, HRQoL deterioration among urban TB patients in Bangladesh during the COVID-19 pandemic was significantly associated with modifiable structural factors. These preliminary findings suggest that appointment scheduling optimisation, service decentralisation, nutritional support, and psychosocial services may reduce pandemic-era HRQoL burden. Prospective longitudinal studies are needed to establish causality and inform programme design.