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

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.

Managing Comorbidities, Determinants and Disability at Start and End of TB Treatment under Routine Program Conditions in China

“…Previous experience of assessing TB patients at the end of TB treatment in 2021 [ 13 ] led to a decision that the study should be carried out in patients from urban and rural settings. Therefore, health facilities that looked after TB patients across mainland China were selected.…”

“…Distance walked in meters was measured using a pedometer or a known length of track. Based on the previous study in China [ 13 ], and based on a study in seven countries in healthy adults [ 16 ], an abnormal 6MWT was defined as walking < 400 m in six minutes. For the initial assessment, the time taken for the health worker to perform the questionnaire assessment and 6MWT was measured.…”

“…There is a dearth of evidence about how post-TB assessments could be carried out in routine healthcare settings. In this regard, the first study in China was conducted in 2021 and assessed the feasibility and value of conducting post-TB assessments in patients consecutively completing TB treatment within a routine programmatic setting [ 13 ]. The assessment was successfully conducted within the routine programmatic setting and health care workers found it feasible and useful to undertake their work.…”

Tuberculosis in older adults: challenges and best practices in the Western Pacific Region

“…The feasibility of conducting post-TB assessment under routine programmatic conditions has been demonstrated in China, and the experience could be adapted to other settings. 171 …”

Holistic Approach to Tuberculosis Detection, Treatment and Prevention: Emerging Evidence and Strategies from the Field

“…It is therefore crucial for National TB Programs to conduct end-of-treatment assessments. This study conducted across four provinces in China by Lin and colleagues [ 8 ] shows that it is feasible to conduct post-TB assessments under routine programmatic conditions (requiring only 20 min of TB program staff’s time on average), and may significantly reduce the morbidity among people who had completed anti-TB treatment (since about half of the individuals screened had ongoing symptoms).…”