Factors associted with defaulting on tuberculosis treatment among HIV infected patients at the Infectious Disease Institute Clinic, Kampala, Uganda
Sawsaw, Osman Abdalla
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INTRODUCTION: Default from TB treatment poses challenges to TB control including the emergence of drug resistant TB, Higher rates of relapse and retreatment and increased treatment expense and need for human resources. In a survey done in 2007 at the Infectious Diseases Institute clinic (IDI), an urban HIV clinic in Kampala Uganda, the annual default rate from TB treatment is 30%. We sought to identify health facility-specific factors and individual characteristics associated with TB treatment default. METHODS: Patients known to have defaulted (n=127) compared to TB patients who had completed treatment (n=217) were compared using an unmatched case control study design. Data on patient perceptions of the health facility and the health care workers as well as individual factors were collected using semi-structured questionnaires. Univariate and multivariate logistic regression analyses were performed. RESULTS: Defaulting from TB treatment was significantly associated with increased distance from home to IDI clinic (AOR 2.22; 95% CI 1.21-4.06, P=0.010), waiting time in the clinic (AOR 4.18; 95%CI 2.18-8.02, P<0.001), Negative conduct of the staff (AOR 2.72; 95%CI 1.02-7.25, P=0.045), Lack of patient opportunity to express feelings (AOR 3.47; 95%CI I.67-7.21, P<0.001), Lack of health education on duration of TB treatment and risk of discontinuing treatment (AOR 5.31, 95%CI I.94-14.7, P=0.001), Lack of knowledge that TB can be cured (AOR 44.11; 95%CI 13.66-142.41, P<0.001), Drug availability (AOR 0.21; 95%CI 0.10-0.44, P<0.001) and lack of side effects of TB treatment. Concurrent treatment with TB treatment (AOR 0.18; 95%CI 0.07-0.44, P<0.001) were negatively associated with defaulting from anti TB treatment. Concurrent treatment with TB treatment and antiretroviral therapy was not associated with defaulting. CONCLUSIONS: Default from TB treatment is influenced by factors including distance from home to treatment centre, long waiting time in the treatment centre, lack of health education, conduct of clinic staff, running out of drugs and fear of side effects of anti-TB treatment. Counselling interventions directed at both staff and patients are an easily implementable improvement which could have far-reaching effects.