Tuberculosis treatment default among HIV-TB co-infected patients in urban UgandaEchec du traitement de la tuberculose chez les patients coinfectes VIH-TB dans les zones urbaines en Ouganda

• Published in: Tropical medicine & international health 2011-08, Vol.16 (8), p.981-987
• Main Authors: Elbireer, Sawsan, Guwatudde, David, Mudiope, Peter, Nabbuye-Sekandi, Juliet, Manabe, Yukari C
• Format: Article
• Language: English
• Subjects: Human immunodeficiency virus; Mycobacterium
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/j.1365-3156.2011.02800.x

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 Abstract: Objectif: Identifier les facteurs specifiques aux etablissements de sante et au patient, associes a l'echec du traitement de la TB chez les patients infectes par le VIH, dans une clinique de TB sur le campus de l'hopital national de reference de Mulago a Kampala, en Ouganda. Methodes: Etude cas-temoins non apparies entre mars et mai 2009. Les cas etaient des patients atteints de TB connus pour avoir manque leur traitement anti-TB, defini comme patients atteints de TB pour lesquels a ete documente un arret du traitement de la TB pendant deux mois consecutifs ou plus pour des raisons autres que l'avis du medecin et qui n'ont pas recu de soins dans un autre etablissement. Les temoins etaient des patients atteints de TB qui ont termine 8 mois de traitement anti-TB sans interruption de deux mois ou plus. Les