Lwevola Paul, Izudi Jonathan, Kimuli Derrick, Komuhangi Alimah, Okoboi Stephen
Institute of Public Health and Management, Clarke International University, Kampala, Uganda.
Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
J Clin Tuberc Other Mycobact Dis. 2021 Aug 28;25:100269. doi: 10.1016/j.jctube.2021.100269. eCollection 2021 Dec.
In most developing countries, tuberculosis (TB) is the leading cause of mortality among people living with the Human Immunodeficiency Virus (PLHIV). Uganda implements TB preventive therapy (TPT) using Isoniazid but data are limited about TPT incompletion. We, therefore, assessed the magnitude of TPT incompletion and the associated factors among PLHIV in a large rural referral health facility in rural eastern Uganda.
We conducted a retrospective data review for PLHIV initiated on TPT between October 2018 and September 2019. The outcome variable was TPT incompletion defined as the failure to finish 6 consecutive months of Isoniazid or failure to finish 9 months of Isoniazid without stopping for more than 2 months at a time. We descriptively summarized numerical data using frequencies and percentages and compared differences in the outcome with independent variables using the Chi-square or fisher's exact, and the Student's t-tests. We used a generalized linear model to assess factors independently associated with TPT incompletion, reported using adjusted odds ratio (aOR) and 95% confidence interval (CI).
We enrolled 959 participants with a mean age of 41.1 ± 13.8 years, 561 (58.5%) were females, 663 (69.1%) married, 538 (56.1) travelled 5-10 km from their place of residence to the ART clinic, 293 (30.6%) had disclosed HIV status, 362 (37.7%) had been on ART for 5-9 years, and 923 (96.2%) were on first-line ART regimen. We found 26 (2.7%) participants had incomplete TPT. Non-adherence to ART clinic visits (aOR, 2.81; 95% CI, 1.09-7.73), history of switch in ART regimen (aOR, 9.33; 95% CI, 1.19-52.39), patient representation (aOR, 4.70; 95% CI, 1.35-13.99), and one unit increase in ongoing counselling session (aOR, 0.67; 95% CI, 0.46-0.91) were associated with TPT incompletion.
We found low rates of TPT incompletion among PLHIV in rural eastern Uganda. Non-adherence to ART clinic visits, patient representation, and history of switch in ART regimen is associated with a higher likelihood of TPT incompletion while ongoing counselling is associated with a reduction in TPT incompletion. The health system should address non-adherence to ART clinic visits and patient representation, through ongoing psychosocial support.
在大多数发展中国家，结核病是人类免疫缺陷病毒感染者（PLHIV）死亡的主要原因。乌干达使用异烟肼实施结核病预防性治疗（TPT），但关于TPT未完成情况的数据有限。因此，我们评估了乌干达东部农村一家大型转诊医疗机构中PLHIV的TPT未完成情况及其相关因素。
我们对2018年10月至2019年9月开始接受TPT的PLHIV进行了回顾性数据审查。结局变量为TPT未完成，定义为未能连续6个月完成异烟肼治疗，或未能在不停药超过2个月的情况下完成9个月的异烟肼治疗。我们使用频率和百分比对数值数据进行描述性总结，并使用卡方检验或费舍尔精确检验以及学生t检验比较结局与自变量之间的差异。我们使用广义线性模型评估与TPT未完成独立相关的因素，报告采用调整后的优势比（aOR）和95%置信区间（CI）。
我们纳入了959名参与者，平均年龄为41.1±13.8岁，561名（58.5%）为女性，663名（69.1%）已婚，538名（56.1%）从居住地到抗逆转录病毒治疗诊所的行程为5 - 10公里，293名（30.6%）已披露HIV感染状况，362名（37.7%）接受抗逆转录病毒治疗5 - 9年，923名（96.2%）采用一线抗逆转录病毒治疗方案。我们发现26名（2.7%）参与者TPT未完成。不坚持到抗逆转录病毒治疗诊所就诊（aOR，2.81；95%CI，1.09 - 7.73）、抗逆转录病毒治疗方案更换史（aOR，9.33；95%CI，1.19 - 52.39）、患者表现（aOR，4.70；95%CI，1.35 - 13.99）以及正在进行的咨询会话增加一个单位（aOR，0.67；95%CI，0.46 - 0.91）与TPT未完成相关。
我们发现乌干达东部农村地区PLHIV的TPT未完成率较低。不坚持到抗逆转录病毒治疗诊所就诊、患者表现以及抗逆转录病毒治疗方案更换史与TPT未完成的可能性较高相关，而正在进行的咨询与TPT未完成的减少相关。卫生系统应通过持续的社会心理支持来解决不坚持到抗逆转录病毒治疗诊所就诊和患者表现的问题。
