Prospective study of self-rated health and its determinants among tuberculosis patients in Armenia

Abstract Background Self-rated health (SRH) is a proven strong predictor of all-cause mortality. In tuberculosis (TB) patients, poor SRH is related to higher disease severity and mortality. This study sought to prospectively measure poor SRH and identify its determinants among primary drug-sensitive TB patients in Armenia. Methods All patients in Armenia diagnosed with primary drug-sensitive TB from Apr, 2019 through Feb, 2021 were targeted for baseline and follow-up interviews at their TB treatment start and shortly after its completion. The instrument included domains on patient's sociodemographic characteristics, TB knowledge, depression, social support, stigma, and health. SRH was measured by a single item with five response options, dichotomized as ‘poor’ versus ‘fair/good/very good/excellent’. Fitted logistic regression models identified predictors of poor SRH at each assessment. Results Overall, 401 patients were interviewed at the baseline and 285 at the follow-up assessments. Between the assessments, the proportion of patients with poor SRH decreased significantly from 18.8% to 4.9% (p < 0.001). Factors related to poor SRH at the baseline assessment included extrapulmonary TB (aOR=2.12, p = 0.025), perceived poor living standards (aOR=2.76, p = 0.006), and presence of depressive symptoms (aOR=4.24, p < 0.001). At the follow-up assessment, internalized social stigma score (aOR=1.09, p = 0.047) and depression score (aOR=1.07, p = 0.04) predicted poor SRH, while TB knowledge score was protective against it (aOR=0.91, p = 0.027). Conclusions This study found significant reduction of poor SRH after completion of anti-TB treatment course. It also revealed several factors that could be targeted for alleviating suffering among TB patients, including providing patients with timely psychological counseling and financial support, and educating patients and their family members to increase their TB-related knowledge and decrease stigma and depression among them. Key messages • Poor SRH decreased significantly after the TB treatment course. Potentially effective protective measures for TB patient’s SRH include their psychological counseling and helping them financially. • Internalized social stigma predicts poor SRH among TB patients even after completion of the TB treatment course, while education on TB have a potential to improve SRH among them.