Alcohol use disorder among patients diagnosed with Tuberculosis in a large urban case-finding project in central Uganda: prevalence, associated factors and lived experiences

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 sought to determine the prevalence of and factors associated with AUD and to understand the lived experiences of patients with alcohol use disorder (AUD). Methods We carried out a mixed methods 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 conducted focus group discussions (FGDs) to understand lived experiences of patients with AUD particularly challenges with adhering to TB treatment. Factors associated with AUD were examined using a multilevel logistic regression model. Focus group discussions were transcribed, data was analysed inductively and coded into themes. Results Out of 325 TB patients interviewed, 62 (18.7% 95% confidence interval [CI] 18–31%) had AUD. Majority 82.3% (51/62) were men. Being male aOR 3.26 (95% CI 1.45, 7.33) and living in an urban area aOR 1.89 (95% CI: 1.01, 3.53) were significantly associated with AUD. Among patients with AUD, there was a trend towards suboptimal TB treatment outcomes, although this did not reach significance aOR 2.15 (95% CI: 0.95, 4.90). Fourteen patients (eight men and six women) with AUD attended two FGDs. Patients with AUD often did not disclose alcohol use and missed clinic refill appointments due to lack of money to pay the transport fare to the clinic. In addition, lack of food coupled with the long treatment duration were challenges to TB treatment completion. Conclusion A large proportion of TB patients have undisclosed AUD and experience several challenges while on TB treatment. TB care programs need to design interventions in order to address AUD.