Psychological distress and its relationship with non-adherence to TB treatment: A multicentre study

Grant Theron, Jonny Peter, Lynn Zijenah, Duncan Chanda, Chacha Mangu, Petra Clowes, Andrea Rachow, Maia Lesosky, Michael Hoelscher, Alex Pym, Peter Mwaba, Peter Mason, Pamela Naidoo, Anil Pooran, Hojoon Sohn, Madhukar Pai, Dan J. Stein, Keertan Dheda

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The successful cure of tuberculosis (TB) is dependent on adherence to treatment. Various factors influence adherence, however, few are easily modifiable. There are limited data regarding correlates of psychological distress and their association with non-adherence to anti-TB treatment. Methods: In a trial of a new TB test, we measured psychological distress (K-10 score), TB-related health literacy, and morbidity (TBscore), prior to diagnosis in 1502 patients with symptoms of pulmonary TB recruited from clinics in Cape Town (n = 419), Harare (n = 400), Lusaka (n = 400), Durban (n = 200), and Mbeya (n = 83). Socioeconomic, demographic, and alcohol usage-related data were captured. Patients initiated on treatment had their DOTS cards reviewed at two-and six-months. Results: 22 %(95 % CI: 20 %, 25 %) of patients had severe psychological distress (K-10 ≥ 30). In a multivariable linear regression model, increased K-10 score was independently associated with previous TB [estimate (95 % CI) 0.98(0.09-1.87); p = 0.0304], increased TBscore [1(0.80, 1.20); p <0.0001], and heavy alcohol use [3.08(1.26, 4.91); p = 0.0010], whereas male gender was protective [-1.47(-2.28, -0.62); p = 0.0007]. 26 % (95 % CI: 21 %, 32 %) of 261 patients with culture-confirmed TB were non-adherent. In a multivariable logistic regression model for non-adherence, reduced TBscore [OR (95 % CI) 0.639 (0.497, 0.797); p = 0.0001], health literacy score [0.798(0.696, 0.906); p = 0.0008], and increased K-10 [1.082(1.033, 1.137); p = 0.0012], and heavy alcohol usage [14.83(2.083, 122.9); p = 0.0002], were independently associated. Culture-positive patients with a K-10 score ≥ 30 were more-likely to be non-adherent (OR = 2.290(1.033-5.126); p = 0.0416]. Conclusion: Severe psychological distress is frequent amongst TB patients in Southern Africa. Targeted interventions to alleviate psychological distress, alcohol use, and improve health literacy in newly-diagnosed TB patients could reduce non-adherence to treatment.

Original languageEnglish (US)
Article number253
JournalBMC infectious diseases
Volume15
Issue number1
DOIs
StatePublished - Jul 1 2015
Externally publishedYes

Keywords

  • Psychological distress
  • Socioeconomic status
  • Treatment non-adherence
  • Tuberculosis

ASJC Scopus subject areas

  • Infectious Diseases

Fingerprint Dive into the research topics of 'Psychological distress and its relationship with non-adherence to TB treatment: A multicentre study'. Together they form a unique fingerprint.

Cite this