Tuberculosis awareness in patients receiving anti-TNF therapy: a survey study

Aims: Tumor necrosis factor (TNF) inhibitors are widely used in the treatment of inflammatory and autoimmune diseases; however, they increase the risk of latent tuberculosis (TB) infection reactivation and active tuberculosis. This study aimed to evaluate tuberculosis-related knowledge and awareness among patients receiving anti-TNF therapy.Methods: This single-center, cross-sectional survey study included adult patients receiving anti-TNF therapy who attended a pulmonology clinic between May and November 2023. An 18-item questionnaire was administered through face-to-face interviews. A composite TB awareness score (range: 0-6) was calculated based on six items, and participants were categorized as having low (0-2), moderate (3-4), or high (5-6) awareness. Associations between awareness levels and clinical characteristics were analyzed, and ordinal logistic regression was performed to identify independent predictors.Results: A total of 145 patients were included. The patients’ mean age was 45.29±12.89 years, and 59.3% were female. Although 87.6% of participants believed that pulmonology consultation was necessary for anti-TNF approval, only 40.7% correctly identified TB screening as the primary purpose of this evaluation, while 46.9% perceived it as only a required signature. Nearly half of the participants (45.5%) reported no knowledge of TB symptoms. Overall, 32.4% of patients had low awareness, 55.2% moderate awareness, and 12.4% high awareness. In univariate ordinal logistic regression analyses, high school education was associated with lower awareness compared to university education, while TB prophylaxis was associated with higher awareness. In multivariate ordinal logistic regression analyses, primary school education was associated with lower awareness compared to university education. Conclusion: TB awareness among patients receiving anti-TNF therapy remained limited, even with regular clinical follow-up. Many patients perceived pulmonology consultations as administrative procedures rather than infection surveillance measures. These findings suggest that structured and repeated patient-centered educational interventions may be necessary to enhance TB awareness and promote appropriate preventive behaviors in this high-risk population.