Improving Health-Related Quality of Life in Drug-Resistant Tuberculosis Patients in Botswana: Insights from BMC Infectious Diseases

Study Design and Settings

This cross-sectional study took place in four healthcare facilities in Botswana offering DR-TB treatment:

1. Princess Marina Hospital (PMH) in Gaborone
2. Nyangabgwe Referral Hospital (NRH) in Francistown
3. Sekgoma Memorial Hospital (SMH) in Serowe
4. Ghanzi Primary Hospital (GPH) in Ghanzi.

Patients diagnosed with DR-TB were treated at either specialized DR-TB sites or primary healthcare facilities. Each patient visited the treatment site monthly for routine checks and consultations.

Study Population

The study examined patients receiving DR-TB treatment from March 1, 2022, to June 30, 2023. Inclusion criteria required patients to:

• Be on DR-TB treatment for a minimum of 4 weeks
• Be 18 years or older
• Understand English or Setswana
• Be followed up at or hospitalized in a DR-TB site.

Patients who were mentally disabled or critically ill were excluded.

Sampling and Sample Size Determination

Enrollment of participants occurred at the four DR-TB sites. Some participants opted out due to repetitive questionnaires.

Piloting and Data Collection

Data collection ran from March 22, 2022, to June 30, 2023. The data collection tool was piloted for two weeks with five participants at PMH. Adjustments were made based on pilot feedback. Eligible participants self-administered an SF-36v2-based questionnaire after giving informed consent. Research assistants helped those unable to write. Patient records provided additional data.

Data Quality Control

Research assistants were trained in data collection. Questionnaire completeness was checked, and entries were cross-verified in Microsoft Excel. The researcher supervised assistants through site visits and virtual calls.

Health-Related Quality of Life Assessment

The SF-36 health survey was chosen for its validity and reliability in measuring HRQoL in TB patients. It includes eight health domains and summarizes scores into physical and mental components. The tool was translated into Setswana and back-translated for accuracy.

Data Processing and Analysis

Data were entered into a password-protected Excel spreadsheet. Missing data estimation (MDE) addressed column 11a discrepancies. Three datasets were created for comparison. The Excel format was made compatible with QualityMetric’s scoring software. Analysis was conducted using Stata 13.1, summarizing categorical data and comparing groups based on treatment duration with one-way ANOVA. Regression analysis identified predictors of HRQoL score variability.