Alcohol use disorder among people diagnosed with Tuberculosis in a large urban case-finding project in central Uganda: prevalence, associated factors and challenges to treatment adherence

Abstract

<title>Abstract</title> Background Heavy consumption of alcohol increases the risk of developing active tuberculosis (TB), contributes to delayed diagnosis and affects adherence to treatment. Within a large urban case-finding project, we aimed to determine the prevalence of and factors associated with alcohol use disorder (AUD) and to understand the challenges that people with AUD face while seeking for TB services and adhering to TB treatment. Methods We carried out an explanatory sequential study in two large urban districts in Uganda. We collected quantitative data on the prevalence of alcohol use disorder using the Cut, Annoyed, Guilty, Eye opener (CAGE) tool. We used a Poisson regression model with robust variance to examine factors associated with AUD. Both the crude and adjusted prevalence risk ratios with 95% confidence intervals were presented. We then conducted two focus group discussions with persons diagnosed with both TB and AUD. Focus group discussions (FGDs) were transcribed, data were analysed inductively and coded into themes using NVIVO version 12 software. Results Out of 325 people with TB people interviewed, 62 (18.7% 95% confidence interval [CI] 18% to 31%) had AUD. Majority 82.3% (51/62) were men. Being male aPR 2.32 (95% CI 1.19, 4.49) and living in an urban area aOR 1.79 (95% CI: 1.10, 2.92) were significantly associated with AUD. Among people with AUD, there was a tendency towards suboptimal TB treatment outcomes, although this did not reach significance aPR 1.65 (95% CI: 0.95, 2.85). Fourteen people (eight men and six women) with diagnosed with AUD attended two FGDs. People with AUD often did not disclose alcohol use during TB treatment and missed clinic refill appointments due to lack of transport fares to the clinic. Conclusion A significant proportion of people with TB have undisclosed AUD and experience several challenges while on TB treatment. TB care programs need to design interventions that actively assess for AUD and in order to address related challenges.