PATIENT PREFERENCES, STRUCTURE, AND HIV ARE ASSOCIATED WITH ADHERENCE TO TUBERCULOSIS TREATMENT IN URBAN UGANDA

Background: Tuberculosis programs have focused only on microbiologic and clinical outcomes of cure and mortality, yet HIV and patient preferences including patient satisfaction and health-related quality of life (HRQoL) may be important determinants of low adherence to prescribed tuberculosis treatment in sub-Saharan Africa. Methods: We applied descriptive and logistic regression to data from a cross-section study of 469 adults with confirmed TB from multiple program clinics in Uganda, and longitudinal mixed effects analysis to a retrospective cohort data of 214 HIV-TB co-infected patients who were randomized to receive 6 months of antiretroviral therapy (ART) concurrent with TB therapy or delayed ART.Results: We demonstrated the following: 1) A huge burden of low adherence of 29% (135/469); 2) Low adherence increased with tuberculosis treatment duration and was modified by HIV; HIV positive patients who had received medication for 5 months were three times more likely to be non adherent (OR 3.21 (95% CI: 1.354, 7.647)) compared to those at 2months after adjusting for age, sex, patient category, drinking status, duration of treatment. Similarly, alcohol intake was associated with low adherence but interactions with HIV were not significant. HIV negative patients with history alcohol intake were two times (OR 2.211 (95% CI: 1.229, 3.980)) more likely to have low adherence, after adjusting for age, sex, patient category, drinking status, duration of treatment; 3) A 4% decrease (OR = 0.964; (95% CI: 0.933, 0.995)) in odds of low adherence with increase in patient satisfaction for organization and processes of clinic set-up among HIV negative patients; 4) A 2% increase in odds of low adherence (OR 1.019 (95% CI: 1.001, 1.036) with increase in patients’ social functioning HRQoL; and 5) Concurrent administration of ART and TB treatment had minimal effects on HRQoL during and after treatment in patients with CD4 above 350 cells. Conclusion: Tuberculosis programs should enhance pre and in-treatment counseling and education on tuberculosis; targeted interventions for patients with history of alcohol intake and patients whose social functioning HRQoL is improving; improve HIV/TB care services and organization and processes of clinic set-up; and offer HAART concurrently with tuberculosis treatment.

Name thesis:degree_name

Doctor of Philosophy

Level thesis:degree_level

doctoral

Discipline thesis:degree_discipline

Epidemiology and Biostatistics

Grantor dc:publisher

Case Western Reserve University School of Graduate Studies

Year dc:date

2013

Author dc:creator

• Babikako, Harriet Mupere

Contributors dc:contributor

• Neuhauser, Duncan

• Epidemiology
• Public Health
• Patient preferences
• Patient satisfaction
• Health-related quality of life
• Adherence
• Tuberculosis
• HIV

Statement dc:rights

• unrestricted
• This thesis or dissertation is protected by copyright: some rights reserved. It is licensed for use under a Creative Commons license. Specific terms and permissions are available from this document's record in the OhioLINK ETD Center.

Language dc:language

English

Repository record dc:identifier

http://rave.ohiolink.edu/etdc/view?acc_num=case1365180107

OAI identifier oai:identifier

oai:etd.ohiolink.edu:case1365180107