Global Health
Persistent Health Challenges Among Post-TB and Post-Pregnancy Survivors with HIV in Uganda: A Case Series Asmith Joseph* Asmith Joseph Adenike McDonald
Introduction
Persons who experience tuberculosis (TB) while pregnant are likely to experience worse post-tb health outcomes. However, there is limited data to support this hypothesis. We identified a unique subgroup of five post-pregnant, post-TB survivors in our ongoing pilot cohort study that started in May 2024 in Kampala, Uganda. We describe their physical, functional, and psychosocial complications compared to age-matched non-post-pregnant controls.
Case Series Presentation
This case series includes five women treated for TB during pregnancy, between two to six months gestation. They were aged 22 to 37 years, had one to four children, 4/5 were HIV-positive, receiving antiretroviral therapy (ART) for 7 months to 8 years. Case 1 was a 22-year-old, para 1, HIV+, on ART for 8 months. Case 2 was a 30-year-old, para 2, HIV+, on ART for 7 months. Case 3 was a 34-year-old, parity unknown, HIV+ on ART for 12 months. Case 4 was a 37-year-old, para 4, HIV+, on ART for 8 years. Case 5 was a 36-year-old, para 1, HIV-. Participants underwent screening for respiratory symptoms, dyspnea using the modified Medical Research Council (mMRC) scale, functional capacity (6-Minute Walk Test), and disability (WHO Disability Assessment Schedule (WHODAS 2.0)).
Discussion
All cases reported some degree of morbidity, with 4 of 5 rating their overall health as moderate to very bad, experiencing productive or persistent cough and breathing difficulties, and 2 of 5 had moderate dyspnea with a score of 3 on the mMRC scale. The median (IQR) 6-minute Walking Distance was 360(357-418) meters versus 379(360-405) meters in the controls and a higher mean disability score of 19 versus 16 in the controls, indicating a worse overall quality of life in the post-TB and post-pregnant women. These findings highlight the post-pregnant TB survivors as a subgroup that needs further research and tailored interventions.