{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T23:25:05Z","timestamp":1786922705525,"version":"build-2736575974"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":84,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Epidemiol Glob Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>United Nations Sustainable Development Goal 3 (Target 3.3) calls for ending the tuberculosis (TB) epidemic by 2030; yet TB programmes in low-income settings remain acutely vulnerable to pandemic disruption. During the COVID-19 first wave, TB patients in urban Bangladesh faced a convergence of disease burden, pandemic-related stressors, and poverty-driven resource constraints. Systematic evidence quantifying health-related quality of life (HRQoL) deterioration in this population and identifying its modifiable structural determinants is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A convergent parallel mixed-methods study was conducted among 439\u00a0TB patients attending 12 Directly Observed Treatment, Short-course (DOTS) clinics across six municipal districts in Dhaka, Bangladesh, between August and September 2020. HRQoL was measured with the EQ-5D-3L and post-traumatic stress with the Impact of Event Scale-Revised (IES-R). Multinomial logistic regression identified factors independently associated with HRQoL deterioration. Concurrently, 36 semi-structured in-depth interviews were analysed using Braun and Clarke's thematic analysis framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Pain or discomfort was reported by 46.5% of participants (95% CI: 41.9\u201351.1%) and anxiety or depression by 36.9% (95% CI: 32.5\u201341.5%). On multivariable analysis, anxiety\/depression was independently associated with larger household size (adjusted OR\u2009=\u20091.08 per person; 95% CI: 1.03\u20131.14;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002), greater distance to the DOTS clinic (adjusted OR\u2009=\u20091.03 per km; 95% CI: 1.01\u20131.05;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and appointment intervals of\u2009\u2264\u200914\u00a0days versus 15\u201330\u00a0days (adjusted OR\u2009=\u20092.86; 95% CI: 1.33\u20137.14;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011). Drug-resistant TB was strongly associated with activity limitation (adjusted OR\u2009=\u200927.7; 95% CI: 8.3\u201392.4). Qualitative analysis identified three themes: stigma intensification through symptom conflation with COVID-19; economic hardship obstructing treatment adherence and nutrition; and perceived inadequacy of government relief for chronically ill populations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this cross-sectional study, HRQoL deterioration among urban TB patients in Bangladesh during the COVID-19 pandemic was significantly associated with modifiable structural factors. These preliminary findings suggest that appointment scheduling optimisation, service decentralisation, nutritional support, and psychosocial services may reduce pandemic-era HRQoL burden. Prospective longitudinal studies are needed to establish causality and inform programme design.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s44197-026-00580-5","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T02:03:49Z","timestamp":1779674629000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Health-Related Quality of Life Deterioration Among Tuberculosis Patients During the COVID-19 Pandemic: a Convergent Mixed-Methods Study of Syndemic Vulnerability in Urban Bangladesh"],"prefix":"10.1007","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-2052-4756","authenticated-orcid":false,"given":"Santu","family":"Das","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5248-1703","authenticated-orcid":false,"given":"Rantu","family":"Das","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"key":"580_CR1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jctube.2019.100121","volume":"17","author":"AN Aggarwal","year":"2019","unstructured":"Aggarwal AN. 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