The adherence–quality of life paradox in tuberculosis care after COVID-19: a cross-sectional study in Indonesia

Tuberculosis (TB) remains one of Indonesia’s most pressing public health challenges, particularly in the post-COVID-19 era. Medication adherence is widely considered critical to TB treatment success and is often linked to improved quality of life (QoL). However, limited research has explored this relationship in Indonesia. This study aimed to assess the correlation between medication adherence and QoL and identify factors influencing these outcomes among TB patients. A cross-sectional study was conducted between June and July 2023 at a large public hospital in Surabaya, East Java. Using purposive sampling, 188 adult TB patients were recruited. Medication adherence was measured using the Medication Adherence Report Scale (MARS-5), while QoL was assessed using the St. George’s Respiratory Questionnaire (SGRQ). Descriptive statistics and Pearson correlation analysis were performed. The majority of patients (80.85%) demonstrated high medication adherence, with a mean MARS-5 score of 24.26 (SD ± 2.9). However, QoL was moderate to poor, with a mean SGRQ score of 46.54 (SD ± 17.44), and the activity domain was most adversely affected. No significant correlation was found between medication adherence and QoL (r = 0.006, p = 0.935). Among patient characteristics, only gender was significantly associated with adherence (p = 0.019). This study highlights a critical disconnect between medication adherence and QoL among TB patients in Indonesia. While adherence remains high, it does not guarantee improved well-being. These findings highlight the importance of integrating QoL assessments and psychosocial support into TB care strategies to achieve more comprehensive, patient-centered outcomes.