Abstract:
Background: Tuberculosis (TB) is one of the world’s leading causes of death from a single
infectious agent and a major cause of deaths related to drug resistance (DR). Uganda, one
of the 30 countries with a high burden of HIV/TB in the world with an estimated 96000
people falling ill with TB annually, has 2 out every 100 people with TB having DR-TB.
Ankole region in Southwestern Uganda has consistently been among regions with a high
DR-TB burden yet no study has been carried out to understand the risk factors of DR-TB
in the region. The study aimed to determine risk factors for DR-TB in Ankole and
specifically to identify the individual risks, assess the social and community risks,
examine the health system risks and explore the experiences and opinions of people
diagnosed with TB.
It was a mixed methods study involving a case-control and a qualitative study targeting
people aged 18 years and above, diagnosed with DR-TB and DS-TB, and health workers.
Quantitative data was collected using a structured questionnaire and qualitative data was
collected through Key informant and In-depth interviews.
Results: Significant independent predictors of DR-TB included previous TB treatment,
(aPOR = 2.0, 95% CI: 1.3–3.0, p = 0.001), other chronic medical conditions (aPOR = 1.8,
95% CI: 1.2–2.6, p = 0.001), Daily alcohol consumption (aPOR = 2.3, 95% CI: 1.7–3.0, p
< 0.001), low income (aPOR = 1.5, 95% CI: 1.1–2.0, p = 0.004). Smoking tobacco was
negatively associated with DR-TB (aPOR = 0.2, 95% CI: 0.1–0.8, p = 0.019). Qualitative
study revealed stigma, lack of transport, inadequate funding of health TB services,
inadequate patient monitoring and follow-up, inadequate knowledge about TB treatment
by transferred staff and patients and reliance on one staff to offer TB services as being
risks.
Conclusions. A combined influence of previous TB treatment, chronic illnesses, daily
alcohol consumption, stigma, lack of transport, and health system-level deficiencies
contributed to DR-TB. Provision of appointment registers to health facilities, integrated
chronic disease management, provision of social protection incentives to all people with
TB, increasing the budget for TB and increased staffing are recommended
