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Rising burden of visual and auditory disability in patients after tuberculosis therapy in Peruvian slums

      Background: With the rise of drug-resistant tuberculosis (TB) worldwide, treatment increasingly involves toxic medications that can cause visual and auditory disability. While close clinical monitoring allows early detection of complications so regimens can be changed before permanent disability, this is not consistently achieved in resource-constrained settings. We aim to assess the prevalence of disability in people with TB disease prior to and following therapy.
      Methods & Materials: Consecutive patients (n = 71) completed a 10-item questionnaire, including Washington Group Short Set Questions, characterising disability before and after completing 6 months of TB treatment in the peri-urban slums of Callao, Peru. Paired pre- and post- treatment disability scores were compared using Wilcoxon signed-rank test.
      Results: Participants were 45% female. Median age was 33 years (inter-quartile range 23-53). Visual disability increased from 30% pre-treatment to 39% post-treatment (P = 0.03), and auditory disability increased from 14% pre-treatment to 27% post-treatment (P = 0.004). Before treatment, difficulty in breathing, climbing stairs, and activities of daily living were reported by 49%, 31%, and 43% of patients, respectively, and all improved (all P < 0.01) following treatment. There was no significant difference between difficulty in concentration pre- and post- treatment (21% versus 23%, respectively, P = 0.9). Disability affecting colour vision, communication, washing and dressing, and sensation were uncommon, affecting <10% of patients. Prevalence of any disability (defined as any disability identifier reported as ‘some difficulty’, ‘a lot of difficulty’, or ‘cannot do at all’) was 77% pre-treatment, and 68% post-treatment (P = 0.1). There was no evidence of an association between pre-treatment disability and previous TB (n = 16, P = 0.1), diabetes (n = 6, P = 0.2), or HIV (n = 4, P = 0.3). Pre-treatment disability was strongly associated with increasing age strata (OR = 6.5, P = 0.01). However, there was no association between increasing age strata and post-treatment deterioration in visual disability (P = 0.96) or auditory disability (P = 0.9).
      Conclusion: Disability is frequent in patients with TB. There is a rising burden of visual and auditory disability in patients following TB treatment. Appropriate-technology visual acuity and audiometry monitoring of patients with TB in resource-limited settings may allow therapy to be modified to prevent permanent disability.