Matiwos Soboka
M. Soboka1, M. Tesfaye2,7, K. Adorjan3,4,7, W. Krahl5,7, E. Tesfaye1, Y. Yitayih1, R. Strobl6, Eva Grill6,7. 1Department of Psychiatry, Medical Faculty, Jimma University, Ethiopia; 2Department of Psychiatry, St. Paul’s Hospital Millennium Medical College, Ethiopia; 3Department of Psychiatry and Psychotherapy, Ludwig Maxmillians University, Munich, Germany; 4Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, Ludwig Maxmillians University, Munich, Germany; 5Department of Forensic Psychiatry, Isar Amper Klinikum, Germany; 6Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig Maxmillians University, Munich, Germany; 7Center for International Health, Ludwig Maxmillians University, Germany
Introduction: Non-adherence to anti-tuberculosis (anti-TB) medication greatly contributes to the rise in multi-drug resistance tuberculosis which is associated with high rates of mortality. Substance use is frequently seen among patients with poor adherence, however, little is known about the effect of substance use on adherence to anti-TB medications in Ethiopia. Therefore, we aimed to assess the effect of substance use disorders on adherence to anti-TB medications in Southwest Ethiopia.
Methods: A prospective cohort study was conducted among 268 patients with tuberculosis attending services at 26 health institutions in Southwest Ethiopia. A structured questionnaire was used to assess substance use disorders, adherence and other potential risk factors for non-adherence. Patients were followed for six months. A generalized linear mixed model was used to identify the effect of substance use disorder on adherence to anti-TB medications. The model fitting was checked using the Bayesian Information Criterion (BIC) while the covariate selection was based on a directed acyclic graph (DAG).
Results: The overall prevalence of non-adherence among patients with substance use disorders was 16•4% (n=22), 41•7 % (n=48), and 45•7% (n=59) at baseline, two months, and six months respectively. The odds of non-adherence to anti-TB medications among patients with khat use disorder was nearly four times that of patients who did not use khat (aOR 3•8, 95%CI=1•8-8•0). Also, patients who have alcohol use disorder were 3•2 times likely to have poor adherence compared to their counterparts (aOR=3•2, 95%CI=1•6-6•6). In addition, being educated (aOR =4•4, 95%CI=1•7-11•3), and being merchant (aOR=6•1, 95%CI=1•2-3•0) were associated with non-adherence to anti-TB medications.
Conclusion: Khat and alcohol use disorders predict a greater likelihood of non-adherence to anti-TB medication. This implies that there is a need to integrate management for substance use disorders into the existing tuberculosis treatment services.