title: Tuberculosis treatment default among HIV-TB co-infected patients in urban Uganda.
abstract: OBJECTIVE
  To identify health facility and patient-specific factors associated with TB treatment default in HIV-infected patients, in a TB clinic on the campus of Mulago National Referral Hospital in Kampala, Uganda.
  
  
  METHODS
  Unmatched case-control study between March and May 2009. Cases were TB patients known to have defaulted on their anti-TB treatment, defined as a TB patient who had documented discontinuation of TB medication for two or more consecutive months due to reasons other than physician's advice and who did not access care at another facility. Controls were TB patients who completed 8 months of anti-TB treatment without interruption of two or more months. Data on health facility-specific factors and individual characteristics were collected using semi-structured questionnaires.
  
  
  RESULTS
  Factors associated with defaulting from TB treatment were: distance from home to clinic (OR 2.22; 1.21-4.06); long waiting time at the clinic (OR 4.18; 2.18-8.02); poor drug availability (OR 4.75; 2.29-9.84); conduct of staff (OR 2.72; 1.02-7.25); lack of opportunity to express feelings (OR 3.47; 1.67-7.21). Other patient-related factors were lack of health education, i.e. not being aware of the duration of treatment or the risk of discontinuing it (OR 5.31; 1.94-14.57); not knowing that TB can be cured (OR 44.11; 13.66-142.41); length of TB treatment (OR 10.77; 5.18-22.41), and side effects of treatment OR 5.53 (2.25-13.61).
  
  
  CONCLUSIONS
  Defaulting is influenced by health systems, staff factors, and patient misinformation. Health education on TB directed at patients combined with staff sensitization could help to improve adherence to TB treatment.
authors.affiliation: Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda. sosman@mujhu.org
authors.forename: Sawsan
authors.initials: S
authors.lastname: Elbireer
authors.forename: David
authors.initials: D
authors.lastname: Guwatudde
authors.forename: Peter
authors.initials: P
authors.lastname: Mudiope
authors.forename: Juliet
authors.initials: J
authors.lastname: Nabbuye-Sekandi
authors.forename: Yukari C
authors.initials: YC
authors.lastname: Manabe
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D013997:Time Factors; D014376:Tuberculosis / Q000150:complications* / Q000188:drug therapy*; D014454:Uganda; D014504:Urban Health
chemical_list: D000995:Antitubercular Agents