Abstract
BackgroundThe successful cure of tuberculosis (TB) is dependent on adherence to treatment. Various factors influence adherence, however, few are easily modifiable. There are limited data regarding correlates of psychological distress and their association with non-adherence to anti-TB treatment.MethodsIn a trial of a new TB test, we measured psychological distress (K-10 score), TB-related health literacy, and morbidity (TBscore), prior to diagnosis in 1502 patients with symptoms of pulmonary TB recruited from clinics in Cape Town (n = 419), Harare (n = 400), Lusaka (n = 400), Durban (n = 200), and Mbeya (n = 83). Socioeconomic, demographic, and alcohol usage-related data were captured. Patients initiated on treatment had their DOTS cards reviewed at two-and six-months.Results22 %(95 % CI: 20 %, 25 %) of patients had severe psychological distress (K-10 ≥ 30). In a multivariable linear regression model, increased K-10 score was independently associated with previous TB [estimate (95 % CI) 0.98(0.09-1.87); p = 0.0304], increased TBscore [1(0.80, 1.20); p <0.0001], and heavy alcohol use [3.08(1.26, 4.91); p = 0.0010], whereas male gender was protective [-1.47(−2.28, −0.62); p = 0.0007]. 26 % (95 % CI: 21 %, 32 %) of 261 patients with culture-confirmed TB were non-adherent. In a multivariable logistic regression model for non-adherence, reduced TBscore [OR (95 % CI) 0.639 (0.497, 0.797); p = 0.0001], health literacy score [0.798(0.696, 0.906); p = 0.0008], and increased K-10 [1.082(1.033, 1.137); p = 0.0012], and heavy alcohol usage [14.83(2.083, 122.9); p = 0.0002], were independently associated. Culture-positive patients with a K-10 score ≥ 30 were more-likely to be non-adherent (OR = 2.290(1.033-5.126); p = 0.0416].ConclusionSevere psychological distress is frequent amongst TB patients in Southern Africa. Targeted interventions to alleviate psychological distress, alcohol use, and improve health literacy in newly-diagnosed TB patients could reduce non-adherence to treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-0964-2) contains supplementary material, which is available to authorized users.
Highlights
The successful cure of tuberculosis (TB) is dependent on adherence to treatment
We explored the association between psychological distress, clinical characteristics, socioeconomic characterstics, and healthcare seeking behaviour, such as the duration of symptoms that passed before patients sought care
Our key findings were that: (i) heavy alcohol usage, female gender, increased morbidity, and previous TB are associated with increased levels of psychological distress amongst patients with symptoms of TB, TB status is not; (ii) increased psychological distress, heavy alcohol usage, decreased health literacy and decreased morbidity are independently associated with non-adherence to treatment; (iii) patients who were more psychologically distressed at treatment initiation had the greatest clinical improvement in symptoms, provided they were adherent; and (iv) HIV-infection and heavy alcohol usage are associated with a delay in seeking care amongst patients with culture-confirmed TB
Summary
The successful cure of tuberculosis (TB) is dependent on adherence to treatment. Various factors influence adherence, few are modifiable. A broad range of patient-specific demographic, financial, and behavioural factors, as well setting-and regimen-specific factors are known to influence adherence [9, 10], most of these, such as household income, are not alterable by healthcare providers. TB patients are known to consider defaulting several times over the course of treatment, with the intensity of their motivation to complete their regimen fluctuating [11, 12]. Those who default are, compared to patients who are adherent, at increased risk of morbidity and mortality, are more likely to develop drug resistance, and are more likely to transmit TB
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