Is It Feasible to Conduct Post-Tuberculosis Assessments at the End of Tuberculosis Treatment under Routine Programmatic Conditions in China?

Yan Lin; Yuqin Liu; Guanghui Zhang; Qinghe Cai; Weihua Hu; Lixin Xiao; Pruthu Thekkur; Jonathan E Golub; Anthony D Harries

doi:10.3390/tropicalmed6030164

Is It Feasible to Conduct Post-Tuberculosis Assessments at the End of Tuberculosis Treatment under Routine Programmatic Conditions in China?

Trop Med Infect Dis. 2021 Sep 10;6(3):164. doi: 10.3390/tropicalmed6030164.

Authors

Yan Lin^{1

2}, Yuqin Liu³, Guanghui Zhang⁴, Qinghe Cai⁵, Weihua Hu³, Lixin Xiao⁶, Pruthu Thekkur^{1

7}, Jonathan E Golub⁸, Anthony D Harries^{1

9}

Affiliations

¹ International Union against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France.
² International Union against Tuberculosis and Lung Disease, No. 1 Xindonglu, Beijing 100600, China.
³ Infectious Disease Hospital of Heilongjiang Province, No. 1 Jianshe Street, Hulan District, Harbin 150500, China.
⁴ Number 8 Hospital of Xinjiang Medical University, No. 106 Yanan Road, Urumqi 830000, China.
⁵ Shantou Institute of Tuberculosis Control and Prevention, No. 1 Honglingjin Road, Shantou 515031, China.
⁶ Xingguo County Institute of Tuberculosis Control and Prevention, No. 26 Yongfu Street, Xingguo 342400, China.
⁷ The Union South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India.
⁸ Johns Hopkins Center for Tuberculosis, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
⁹ Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.

Abstract

There is growing evidence that a substantial proportion of people who complete anti-tuberculosis treatment experience significant morbidity and mortality which can negatively affect their quality of life. It is suggested that national tuberculosis programs conduct end-of-treatment assessments, but whether this is feasible is currently not known. We therefore assessed whether tuberculosis program staff could assess functional and general health status of patients at the end of treatment in five TB clinics in four provinces in China. There were 115 patients, aged 14-82 years, who completed anti-tuberculosis treatment and a post-TB assessment. There were 54 (47%) patients who continued to have symptoms, the commonest being cough, dyspnea and fatigue. Symptom continuation was significantly more common in the 22 patients with diabetes (p = 0.027) and the 12 patients previously treated for TB (p = 0.008). There were 12 (10%) current smokers, an abnormal chest X-ray was found in 106 (92%) patients and distance walked in the 6-min walking test (6MWT) ranged from 30-750 m (mean 452 ± 120); 24 (21%) patients walked less than 400 m. Time taken to perform the post-TB assessment, including the 6MWT, ranged from 8-45 min (mean 21 ± 8 min). In 98% of the completed questionnaires, health workers stated that conducting post-TB assessments was feasible and useful. This study shows that post-TB assessments can be conducted under routine programmatic conditions and that there is significant morbidity that needs to be addressed.

Keywords: 6-min walking test; China; chest-radiography; current cigarette smoking; diabetes mellitus; post-TB assessment; post-TB symptoms; time taken to complete post-TB assessment; tuberculosis.