Psychological distress and its relationship with non-adherence to TB treatment: a multicentre study
Abstract
Background
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.
Methods
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.
Results
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].
Conclusion
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.
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Source:
BMC Infectious Diseases
