The impact of direct observed therapy on daily living activities, quality of life and socioeconomic burden on patients with tuberculosis in primary care in Singapore

Abstract

Introduction: The prevalence of tuberculosis (TB) is rising in Singapore. The affected patients are provided with free directly observed therapy (DOT) at local polyclinics. The impact of DOT on their daily living activities (DLA) and quality of life (QOL) may affect their treatment adherence. The study aimed to evaluate the effect of DOT on the DLA and QOL of patients with TB and to quantify their socioeconomic burden. Material and methods: This questionnaire survey recruited adult multi-ethnic Asian patients with TB who were on DOT at nine local polyclinics. The questionnaire collected data on their demographic characteristics and DLA, anti-TB medications, the validated WHOQOL-BREF instrument, and socioeconomic costs. The associations between DOT and independent variables were tested using Student’s t-test and ANOVA. Results: The 356 patients recruited comprised 63% males with mean age of 43 years; 73% of them were employed, 73% reported increased travel time (mean 41 minutes/DOT visit) and DOT-related cost (mean S$260-S$389 for 6-9 months’ treatment); 47% indicated reduced participation in social functions and 45% felt that DOT had caused disruptions to their work, especially among younger patients. The WHOQOL-BREF scores were 13.3/20 “Physical Health”, 12.6/20 “Psychological”, 13.4/20 “Social Relationships” and 12.3/20 “Environment” domains, respectively. Some 52% of them rated their QOL as “good” or “very good”, 47% reported satisfaction with their health but 74% experienced negative feelings such as despair, anxiety and depression. Conclusion: The DOT affected patients’ DLA, QOL and increased their socioeconomic burden, which should be addressed by appropriate mitigating measures in the community.