Stigma and health-related quality of life (HRQoL) among people with multidrug-resistant tuberculosis (MDR-TB): A cross-sectional study in Indonesia

Bustanul Arifin; Muhamad G. Sarwadan; Elly Wahyudin; Latifah M. Sarifah; Ahmad Fuady; Fredrick D. Purba; Sylmina D. Alkaff; Akhmad Ardiansyah; Jamaluddin Madolangan

doi:10.52225/narra.v5i2.1317

Authors

Bustanul Arifin Department of Pharmacy, Faculty of Pharmacy, Universitas Hasanuddin, Makassar, Indonesia; Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands https://orcid.org/0000-0002-2303-310X
Muhamad G. Sarwadan Department of Pharmacy, Faculty of Pharmacy, Universitas Hasanuddin, Makassar, Indonesia https://orcid.org/0009-0005-5965-0598
Elly Wahyudin Department of Pharmacy, Faculty of Pharmacy, Universitas Hasanuddin, Makassar, Indonesia
Latifah M. Sarifah Labuang Baji Hospital, Makassar, Indonesia
Ahmad Fuady Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Primary Health Care Research and Innovation Center, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia https://orcid.org/0000-0003-0030-0524
Fredrick D. Purba Faculty of Psychology, Universitas Padjadajaran, Jatinangor, Indonesia https://orcid.org/0000-0002-7336-3043
Sylmina D. Alkaff Robotics and Artificial Intelligence, Department of Engineering, Faculty of Advanced Technology and Multidiscipline, Universitas Airlangga, Surabaya, Indonesia https://orcid.org/0000-0001-9282-3394
Akhmad Ardiansyah Department of Pharmacy, Universitas Sembilanbelas November Kolaka, Kolaka, Indonesia https://orcid.org/0000-0003-0522-7696
Jamaluddin Madolangan Labuang Baji Hospital, Makassar, Indonesia; Department of Tuberculosis Disease, Labuang Baji Hospital, Makassar, Indonesia; Departement of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Hasanuddin, Makassar, Indonesia

DOI:

https://doi.org/10.52225/narra.v5i2.1317

Keywords:

EQ-5D-5L index scores, HRQoL, Indonesia, MDR-TB, stigma

Abstract

Stigma often accompanies people with multidrug-resistant tuberculosis (MDR-TB) and potentially affects their health-related quality of life (HRQoL). The aim of this study was to investigate the stigma faced by patients with MDR-TB, both from the patients' and community's perspective, and its relationship with HRQoL. Data was gathered at the provincial hospital in Makassar, South Sulawesi, Indonesia. The instrument employed in this research was the Indonesian version of the tuberculosis (TB) stigma instrument to assess MDR-TB stigma from the patient and community perspectives. The patient perspective represents how individuals with TB perceive and experience stigma, including the fear of disclosure, isolation, and guilt (feeling responsible for the burden on their family or their own risky behaviors). Meanwhile, the community perspective reflects how individuals with TB perceive societal attitudes towards them, such as social distancing, avoidance, and reluctance to interact. HRQoL was measured using the European quality of life-5 dimensions-5 level version (EQ-5D-5L) instrument. Notably, the evaluation of anxiety and depression is centered on the fifth dimension of the EQ-5D-5L instrument. A total of 210 patients with MDR-TB were included in the study, all of whom reported experiencing stigma. Most participants perceived stigma at a moderate level, with 76% from the patient perspective and 71% from the community perspective. The average EQ-5D-5L index score was 0.72 (95% confidence interval (95%CI): 0.68–0.76). Measurements from both perspectives show similar scores. There is a substantial negative association between the level of stigma and HRQoL, both from the patient's perspective (R²=-0.33; F=102.52; p<0.001) and the community's (R²=-0.32; F=96.76; p<0.001). The study highlights that the stigma of MDR-TB significantly affects the HRQoL from the patient and community perspective.