Psychological distress and its relationship with non-adherence to TB treatment: a multicentre study.
Journal: BMC infectious diseases
Volume: 15
Issue:
Year of Publication: 2016
Affiliated Institutions:
Lung Infection and Immunity Unit, Division of Pulmonology & UCT Lung Institute, Department of Medicine, University of Cape Town, H Old Main Building, Groote Schuur Hospital, Observatory, Cape Town, , South Africa. grant.theron@uct.ac.za.
Lung Infection and Immunity Unit, Division of Pulmonology & UCT Lung Institute, Department of Medicine, University of Cape Town, H Old Main Building, Groote Schuur Hospital, Observatory, Cape Town, , South Africa. jonny.g.peter@gmail.com.
Department of Immunology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe. lzijenah@gmail.com.
University Teaching Hospital, Lusaka, Zambia. duncanchanda@gmail.com.
National Institute of Medical Research, Mbeya Medical Research Centre, Mbeya, Tanzania. cmangu@nimr-mmrc.org.
National Institute of Medical Research, Mbeya Medical Research Centre, Mbeya, Tanzania. pclowes@mmrp.org.
National Institute of Medical Research, Mbeya Medical Research Centre, Mbeya, Tanzania. Rachow@lrz.uni-muenchen.de.
Department of Medicine, University of Cape Town, Cape Town, South Africa. lesosky@gmail.com.
Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany. hoelscher@lrz.uni-muenchen.de.
South African Medical Research Council, Durban, South Africa. alexanderpym@hotmail.com.
University Teaching Hospital, Lusaka, Zambia. pbmwaba@yahoo.com.
Biomedical Research & Training Institute, Harare, Zimbabwe. pmasonzim@gmail.com.
Population Health, Health Systems and Innovation (PHHSI)/HIV/STIs and TB (HAST) Research Programmes, Human Sciences Research Council, Cape Town, South Africa. pnaidoo@hsrc.ac.za.
Lung Infection and Immunity Unit, Division of Pulmonology & UCT Lung Institute, Department of Medicine, University of Cape Town, H Old Main Building, Groote Schuur Hospital, Observatory, Cape Town, , South Africa. anil.pooran@gmail.com.
McGill International TB Centre & Department of Epidemiology & Biostatistics, McGill University, Montreal, Canada. dhjsohn@gmail.com.
McGill International TB Centre & Department of Epidemiology & Biostatistics, McGill University, Montreal, Canada. madhukar.pai@mcgill.ca.
Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa. Dan.Stein@uct.ac.za.
Lung Infection and Immunity Unit, Division of Pulmonology & UCT Lung Institute, Department of Medicine, University of Cape Town, H Old Main Building, Groote Schuur Hospital, Observatory, Cape Town, , South Africa. Keertan.dheda@uct.ac.za.
Abstract summary
The 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.In 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.22 %(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].Severe 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.
Authors & Co-authors:
Theron Grant G
Peter Jonny J
Zijenah Lynn L
Chanda Duncan D
Mangu Chacha C
Clowes Petra P
Rachow Andrea A
Lesosky Maia M
Hoelscher Michael M
Pym Alex A
Mwaba Peter P
Mason Peter P
Naidoo Pamela P
Pooran Anil A
Sohn Hojoon H
Pai Madhukar M
Stein Dan J DJ
Dheda Keertan K
Study Outcome
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