Adherence to tuberculosis treatment and associated factors among adult HIV/TB co-infected out-patients in the continuous treatment phase in Kampala, Uganda

Abstract

Introduction: Tuberculosis (TB) is one of the major public health problems worldwide, mainly affecting middle and low-income countries which account for over 80% of TB cases and deaths. Treatment acceptance and adherence among high-risk populations such as people living with HIV (PLWHIV) have stagnated despite the different strategies that have been in existence to improve TB care among patients. The level of adherence to TB treatment among HIV/TB co-infected patients is under-documented, especially in urban health facilities. Furthermore, it has not been well established how the duration on ART affects the determinants of patients’ adherence to TB treatment among HIV/TB co-infected patients. This study aimed to assess the level of adherence to tuberculosis treatment, associated factors and how the duration on ART modifies the effect of the factors among HIV/TB co-infected out-patients in the continuous treatment phase in Kampala, Uganda. Methods and materials: The study employed a cross-sectional design applying quantitative data collection methods that involved 243 participants. An interviewer-administered semi-structured questionnaire was used to collect data, which was then cleaned and analyzed using Microsoft Excel and STATA 15 software. Modified Poisson regression was used to obtain prevalence ratios as a measure of association where statistical significance of p < 0.05 was used for statistical inference. Results: The level of adherence to TB treatment among HIV/TB co-infected patients was 85.2%. Factors associated with TB treatment adherence were; having been on ART for 6-12 months (aPR = 1.26, 95% CI: 1.05-1.50) and more than 12 months (aPR = 1.29, 95% CI: 1.11-1.51), having had TB for 4 months or more (aPR = 0.88, 95% CI: 0.80-0.96), having previously been on TB treatment (aPR = 0.73, 95% CI: 0.59-0.91), living more than 10 kilometres from the TB treatment facility (aPR = 1.09, 95% CI: 1.00-1.19), and having a high score on perceived TB treatment barriers (aPR = 0.52, 95% CI: 0.36-0.75). Effect modification was positive for patients who had TB for 4 months or more (Stratified aPR = 1.38, 95% CI: 1.00-1.89) and those who had previously been on TB treatment (relapses) (Stratified aPR = 0.49, 95% CI: 0.33-0.75) where their duration on ART was more than 12 months. Conclusion and recommendation: The study’s findings suggest that healthcare providers should adopt patient-centred care, offering counselling and psychosocial support, while monitoring adherence closely. Policymakers including the Ministry of Health, HIV/TB program managers and District Health administrators must integrate services, enhance healthcare infrastructure, and invest in training healthcare providers. Additionally, community engagement and stigma reduction through conducting health outreaches in a bid to foster awareness in communities and empower HIV/TB coinfected individuals organized by the Ministry of Health, HIV/TB program managers, and healthcare providers among others are vital to significantly improve treatment adherence and outcomes for this vulnerable population.