Fifty subjects diagnosed with DR TB were enrolled from May 2019 to July 2021. During the 10 months follow-up, 18 participants withdrew from the study due to reasons cited below. At month 20, 28 remained in the study (Fig. 1).

Of the 50 participants enrolled in the study, we present the socio-demographic characteristics of 46 who filled in SF36, QoL and K10 questionnaires at week two after enrolment (“baseline”). A large proportion of the study population (71.7%) were males. Majority of the participants (47.8%) were aged 50 years and above and the median age at baseline was 48.9 years. 34.8% of the participants had tertiary or higher education, 32.6% had vocational training, and 65.2% were employed. More than half of the participants (63.04%) were either married or living with a partner. A total of 48.0% of the participants had a previous history of TB and the most common symptom reported was cough (95.7%) followed by weight loss (71.7%) and night sweats (50.0%). The median BMI was found to be 19.7 with an interquartile range between 16.6 and 22.5. Many of the participants were cigarette smokers (58.7%) and 34.2% consumed alcohol 4 or more times per week. Hypertension was found to be a major comorbidity among the participants. The variable age, sex, marital status, employment status, education and previous history of TB were compared between the group that completed the study and the group that discontinued from the study with no significant differences found (see Annex 1). A detailed description of baseline socio-demographic characteristics and medical history are presented in Table 1.

At the treatment start, 17.4% of the participants had to use their household savings for managing their treatment costs and 4.4% had borrowed money. Initially only 8.7% of the participants received a social welfare payment but at the end of the month 20, it increased to 60.7%. Similar trend was observed in receiving vouchers or goods. When questioned about the impact of TB, 60.9% had responded that TB affected their social and private life. At the month 10 and 20, 18.8% and 14.3% respectively stated that they had very serious financial impact of TB (Table 2).

Before the TB diagnosis, more than half of the participants (60.9%) were employed as formal paid worker and 15.2% had retired. At the baseline, at month 10 and months 20, the employment status of the majority shifted from being employed to being on sick leave. More than half (58.7%) were on sick leave at baseline, 50.0% at month 10 and 35.7% at month 20. Unemployment also increased during the duration of the treatment. At the baseline, only 3 (6.5%) participants were unemployed but at the end of month 20, 7 (25.0%) participants remained unemployed (Fig. 2). A total of 31 participants stated that they had to stop working due to TB-related illness.

Employment trend - before TB, at the baseline, month 10, and month 20

A total of 36 participants had mentioned their personal income before the diagnosis of TB and 29 mentioned their personal income at baseline. Not all the participants revealed their personal and family income. Before the TB diagnosis, 16 (34.8%) participants had an income between 1,000 RON and 2,000 RON and 12 (26.1%) had an income range between 2,000 RON and 3,000 RON (1 EUR is approximately 5 RON and the net minimum salary in Romania in 2023 was set at 1863 RON (373.90€)). This can be attributed to the fact that majority of them were employed in the formal sector. At baseline, only 7 (15.2%) reported their income range to be between 1,000 and 1,500 RON and 11 (23.9%) of them had an income range of 0-500 RON. The change in the income could be due to the change in employment status from employed to being on sick leave. At month 10, 6 (18.8%) of them received an income between 0 and 500 RON and 8 (25.0%) had an income between 1,000 RON and 2,500 RON. At month 20, 3 (10.7%) had an income between 500 RON and 1,000 RON, and 5 (17.8%) had income range between 0 RON and 500 RON. See Fig. 3 for more details.

Personal income trend – before TB, at the baseline, at month 10 and month 20

Before TB diagnosis, 16 (34.8%) of the participants had a household income between 2,000 RON and 4,000 RON. However, at baseline, month 10 and month 20 the majority of the participant’s household income declined to the range between 0 RON and 2,000 RON (Fig. 4).

Household income trend – before TB, at the baseline, at month 10 and month 20

Participants reported a physical health component summary score (PCS) with a mean of 67.0 (SD 33.9) at baseline, 63.3 (SD 31.9) at month 10 and 70.3 (SD 30.3) at month 20. The mean mental health component summary score (MCS) was 62.8 (SD 30.6) at baseline, 67.8 (SD 29.0) at month 10 and 70.8 (SD 27.3) at month 20. Although the scores in all the domains except role physical and bodily pain seemed to be improving differences were not significant. Table 3 displays the scores in all the domains obtained by the participants at baseline, at months 10 and month 20.

The difference in the PCS and MCS scores were compared stratified by sex, age groups and history of TB. The resulting p-values were non-significant stating that there were no differences in the MCS and PCS values based on sex and history of TB. There was a negative correlation between PCS score and the age group category “>/= 50” (p-value = 0.02) indicating that as the age increases, there is a decrease in the PCS score.

Majority of the participants (73.9%, 68.8%, 60,7%) reported a score less than 20 at baseline, month 10 and month 20, respectively. 3 (10.7%) of the participants had a score more than or equal to 30 at month 20, indicating severe psychological distress (Fig. 5). There was no difference in the scores during the treatment period (p-value = 0.78). The K-10 scores at month 20 were compared based on sex, age, history of TB, relationship status and employment status, and findings were non-significantly different.

K-10 scores at baseline, month 10 and month 20