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. 2025 Mar 5;20(1):10.
doi: 10.1186/s13011-024-00629-3.

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

Josephine Bayigga  1 , Ilona Kakai  1 , Eva Agnes Laker Odongpiny  1 , Ahmed Ddungu  1 , Lynn Semakula  1 , Martha Nansereko  1 , Christine Sekaggya Wiltshire  1 , Turyahabwe Stavia  2 , Stella Zawedde-Muyanja  3   4
Affiliations

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

Josephine Bayigga et al. Subst Abuse Treat Prev Policy. .

Abstract

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] 18-31%) screened positive for AUD. Majority 82.3% (51/62) were male. 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 a positive screen. Among people who screened positive for 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 male and six female) who screened positive for AUD attended two FGDs. These respondents 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 screened positive for AUD but did not disclose alcohol use to their healthcare workers. These patients experienced several challenges while on TB treatment. Therefore, TB care programs need to design interventions that actively assess for AUD and in order to address related challenges.

Keywords: Alcohol use disorder; Experiences; Treatment outcomes; Tuberculosis; Uganda.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study obtained ethical approval from the Makerere University College of Health Sciences School of Biomedical Sciences Research and Ethics Committee (SBS-REC) and the Uganda National Council for Science and Technology (Approval reference number HS1106ES). All study participants provided written informed consent before enrolment. The study was conducted in compliance with Good Clinical practice guidelines. Consent for publication: This declaration is not applicable as no individual data has been published in this manuscript. Competing interests: The authors declare no competing interests.

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