Background Multi-drug-resistant tuberculosis (MDR-TB) treatment involves toxic drugs that cause adverse events (AEs), which are life-threatening and may lead to death if not well managed. In Uganda, the prevalence of MDR-TB is increasingly high, and about 95% of the patients are on treatment. However, little is known about the prevalence of AEs among patients on MDR-TB medicines. We therefore estimated the prevalence of reported adverse events (AEs) of MDR-TB drugs and factors associated with AEs in two health facilities in Uganda. Methods A retrospective cohort study of MDR-TB was conducted among patients enrolled at Mulago National Referral and Mbarara Regional Referral hospitals in Uganda. Medical records of MDR-TB patients enrolled between January 2015 and December 2020 were reviewed. Data on AEs, which were defined as irritative reactions to MDR-TB drugs, were extracted and analyzed. To describe reported AEs, descriptive statistics were computed. A modified Poisson regression analysis was used to determine factors associated with reported AEs. Results Overall, 369 (43.1%) of 856 patients had AEs, and 145 (17%) of 856 had more than one. Joint pain (244/369, or 66%), hearing loss (75/369, or 20%), and vomiting (58/369, or 16%) were the most frequently reported effects. Patients started on the 24-month regimen (adj. PR = 1.4, 95%; 1.07, 1.76) and individualized regimens (adj. PR = 1.5, 95%; 1.11, 1.93) were more likely to suffer from AEs. Lack of transport for clinical monitoring (adj. PR = 1.9, 95%; 1.21, 3.11); alcohol consumption (adj. PR = 1.2, 95%; 1.05, 1.43); and receipt of directly observed therapy from peripheral health facilities (adj. PR = 1.6, 95%; 1.10, 2.41) were significantly associated with experiencing AEs. However, patients who received food supplies (adj. PR = 0.61, 95%; 0.51, 0.71) were less likely to suffer from AEs. Conclusion The frequency of adverse events reported by MDR-TB patients is considerably high, with joint pain being the most common. Interventions such as the provision of food supplies, transportation, and consistent counseling on alcohol consumption to patients at initiation treatment facilities may contribute to a reduction in the rate of occurrence of AEs.

ObjectivesWe determined the prevalence of controlled prescription drug (CPD) non-medical and lifetime use and their predictors among patients at three public psychiatric clinics in Uganda to identify missed care opportunities, enhanced screening priorities, and drug control needs.MethodsA cross-sectional survey of 1275 patients was performed from November to December 2018. Interviewer-administered semi-structured questionnaires, desk review guide and urine drug assays were employed. Questionnaire recorded CPD non-medical and illicit drug use history from patients’ files, CPD lifetime use and risk factors. Desk review guide recorded recently prescribed drugs in patients’ files to corroborate with urine assays. Predictors were analysed by multivariate logistic regression.ResultsFrom desk review, 145 (11.4%) patients had history of CPD non-medical use and 36 (2.8%) had used illicit drugs. Of 988 patients who provided urine, 166 (16.8%) self-medicated CPDs, particularly benzodiazepines while 12 (1.2%) used illicit drugs. Of those with drug-positive urine, 123 (69.1%) had no documented history of CPD non-medical and illicit drug use. Being an inpatient (OR=10.90, p<0.001) was independently associated with CPD non-medical use. Additionally, being an inpatient (OR=8.29, p<0.001) and tobacco consumption (OR=1.85, p=0.041) were associated with CPD non-medical and illicit drug use combined. Among participants, 119 (9.3%) reported CPD lifetime use, and this was independently associated with education level (OR=2.71, p<0.001) and history of treatment for substance abuse (OR=2.08, p=0.018).ConclusionsCPD non-medical use is common among Uganda’s psychiatric patients, and more prevalent than illicit drug use. Rapid diagnostic assays may be needed in psychiatric care in resource limited settings. It is necessary to assess how CPD non-medical use impacts mental care outcomes and patient safety. High risk groups like inpatients and tobacco consumers should be prioritised in psychiatric screening.

Background Multi-drug resistant tuberculosis (MDR-TB) treatment involves toxic drugs that cause adverse-drug-effects (ADEs), which are life threatening and may lead to death if not well managed. In Uganda, the prevalence of MDR-TB is increasingly high and about 95% of the patients are on treatment. However, little is known about the prevalence of ADEs among the patients on MDR-TB medicines. We therefore estimated the prevalence of ADEs of MDR-TB drugs and factors associated with ADEs in two health facilities in Uganda. Methods Between March and November 2021, we conducted a retrospective cohort study of MDR-TB patients enrolled at Mulago national referral and Mbarara regional referral hospitals in Uganda. We reviewed files of MDR-TB patients enrolled between January 2015 and December 2020. We extracted data on ADEs, defined as irritative reactions to MDR-TB drugs. We conducted descriptive analysis and modified Poisson regression analysis to determine factors associated with ADEs. Results A total of 856 files were reviewed. Overall, 369 (43.1%) of 856 patients had ADEs and 145 (17%) of 856 suffered from more than one. The most recorded effects were: joint pain (244/369 (66%)); hearing loss (75/369(20%)); and vomiting (58/369(16%)). Patients started on the 24 months regimen (adjusted prevalence ratio (adj.PR=1.4, 95%; 1.07, 1.76) and individualized regimens (adj.PR=1.5, 95%; 1.11, 1.93) were more likely to suffer from ADEs. Lack of transport for clinical monitoring (adj.PR=1.9, 95%; 1.21, 3.11); alcohol consumption (adj.PR=1.2, 95%; 1.05, 1.43), and receipt of directly-observed-therapy from peripheral health facilities (adj.PR=1.6, 95%; 1.10, 2.41) were significantly associated with experiencing ADEs. However, patients who received food supplies (adj.PR=0.61, 95%; 0.51, 0.71) were less likely to suffer from ADEs. Conclusion Adverse-drug-effects were high among MDR-TB patients and joint-pains was the commonest effect. Interventions such as provision of food supplies, transport and consistent counselling on alcohol consumption to patients at initiation treatment facilities may reduce ADEs