Tuberculosis treatment default among HIV-TB co-infected patients in urban Uganda

Sawsan Elbireer, David Guwatudde, Peter Mudiope, Juliet Nabbuye-Sekandi, Yukari C. Manabe

Research output: Contribution to journalArticlepeer-review

Abstract

Objective To identify health facility and patient-specific factors associated with TB treatment default in HIV-infected patients, in a TB clinic on the campus of Mulago National Referral Hospital in Kampala, Uganda. Methods Unmatched case-control study between March and May 2009. Cases were TB patients known to have defaulted on their anti-TB treatment, defined as a TB patient who had documented discontinuation of TB medication for two or more consecutive months due to reasons other than physician's advice and who did not access care at another facility. Controls were TB patients who completed 8 months of anti-TB treatment without interruption of two or more months. Data on health facility-specific factors and individual characteristics were collected using semi-structured questionnaires. Results Factors associated with defaulting from TB treatment were: distance from home to clinic (OR 2.22; 1.21-4.06); long waiting time at the clinic (OR 4.18; 2.18-8.02); poor drug availability (OR 4.75; 2.29-9.84); conduct of staff (OR 2.72; 1.02-7.25); lack of opportunity to express feelings (OR 3.47; 1.67-7.21). Other patient-related factors were lack of health education, i.e. not being aware of the duration of treatment or the risk of discontinuing it (OR 5.31; 1.94-14.57); not knowing that TB can be cured (OR 44.11; 13.66-142.41); length of TB treatment (OR 10.77; 5.18-22.41), and side effects of treatment OR 5.53 (2.25-13.61). Conclusions Defaulting is influenced by health systems, staff factors, and patient misinformation. Health education on TB directed at patients combined with staff sensitization could help to improve adherence to TB treatment.

Original languageEnglish (US)
Pages (from-to)981-987
Number of pages7
JournalTropical Medicine and International Health
Volume16
Issue number8
DOIs
StatePublished - Aug 2011

Keywords

  • HIV
  • Treatment default
  • Tuberculosis

ASJC Scopus subject areas

  • Parasitology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

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