Observational studyBMC public health2025
One year on - the long-term impact of COVID-19 pandemic and government restrictions on the health-seeking behaviour, financial security and mental health of TB survivors.
Observational study in BMC public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPeople with tuberculosis (TB) may face long-term physical and psycho-social-economic disability related to TB treatment. The Corona Virus Disease 2019 (COVID-19) pandemic and government restrictions disrupted health care services. We describe health-seeking behaviour, perceived financial impact, and the mental health of TB survivors one year after the COVID-19 pandemic. We further explore factors associated with the perceived impact of COVID-19 and government restrictions on health-seeking behaviour.
methodsThis is a cross-sectional study nested in an ongoing observational TB Sequel cohort study. Adults (≥ 18yrs) who had completed treatment for drug-susceptible pulmonary TB in South Africa, the Gambia, and Mozambique before the start of the COVID-19 pandemic, completed a COVID-19 questionnaire which included the WHO tool for Behavioural Insights on COVID-19, the Kessler Psychological Distress Scale (K10) and Medical Outcomes Short Form Survey (SF-36) for health-related quality of life. Questionnaires were administered during scheduled TB Sequel follow-up study visits between 04/2021 and 10/2021. We used publicly available data on the number of COVID-19 cases and the start and end date of each wave to define country-specific COVID-19 "in-wave" and "out-of-wave" phases. We compared psycho-social and economic measures reported during these phases. In addition, we explored factors associated with poor health-seeking behaviour (comprised of moderate or serious impact) using logistic regression.
resultsFour hundred eighty seven TB survivors (69% male, median age 33 years IQR 25-42, median time since TB treatment completion 16 months IQR 13-27) completed the COVID-19 questionnaire. About a quarter of TB survivors reported that their financial status (n = 117; 24%) or their health-seeking behaviour for any health condition (n = 128; 26%) had been seriously impacted by COVID-19 and the governments' response. A third of patients (30.4%) reported using coping strategies. Logistic regression indicated that males, living with HIV and being on antiretroviral treatment (ART), being impacted financially during COVID-19, and experiencing social changes, were associated with poor health-seeking behaviour.
conclusionGovernments' response to COVID-19 affected TB survivors' healthcare-seeking behaviour, financial status and mental health. The long-term adverse effects on health-seeking behaviour are important for TB survivors who are at increased risk for recurrent disease and long-term disability in the first two years after treatment completion.
trial registrationClinical trial number: not applicable.
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