Discontinuation of tuberculosis treatment among children in the Kampala Capital City Authority health facilities: a mixed-methods study

Abstract

Introduction Discontinuation of tuberculosis treatment (DTT) among children in sub-Saharan Africa is a major obstacle to effective tuberculosis (TB) control and has the potential to worsen the emergence of multi-drug resistant TB and death. DTT in children is understudied in Uganda. We examined the level and factors associated with DTT among children at four large health facilities in Kampala Capital City Authority and documented the reasons for DTT from treatment supporters and healthcare provider perspectives. Methods We conducted a retrospective analysis of records for children < 15 years diagnosed and treated for TB between January 2018 and December 2019. We held focus group discussions with treatment supporters and key informant interviews with healthcare providers. We defined DTT as the stoppage of TB treatment for 30 or more consecutive days. We used a stepwise generalized linear model to assess factors independently associated with DTT and content analysis for the qualitative data reported using sub-themes. Results Of 312 participants enrolled, 35 (11.2%) had discontinued TB treatment. The reasons for DTT included lack of privacy at healthcare facilities for children with TB and their treatment supporters, the disappearance of TB symptoms following treatment initiation, poor implementation of the community-based directly observed therapy short-course (CB-DOTS) strategy, insufficient funding to the TB program, and frequent stock-outs of TB drugs. DTT was more likely during the continuation phase of TB treatment compared to the intensive phase (Adjusted odds ratio (aOR), 5.22; 95% Confidence Interval (CI), 1.76–17.52) and when the treatment supporter was employed compared to when the treatment supporter was unemployed (aOR, 3.60; 95% CI, 1.34–11.38). Conclusion Many children with TB discontinue TB treatment and this might exacerbate TB morbidity and mortality. To mitigate DTT, healthcare providers should ensure children with TB and their treatment supporters are accorded privacy during service provision and provide more information about TB symptom resolution and treatment duration versus the need to complete treatment. The district and national TB control programs should address gaps in funding to TB care, the supply of TB drugs, and the implementation of the CB-DOTS strategy.

Influence of Public Health Services on the Goal of Ending Tuberculosis: Evidence From Panel Data in China

“…Improving the utilization rate of PHS for TB could reduce the incidence and mortality in high-risk populations (8). In South Africa, discontinuation of TB treatment services for children was the main cause of the continuous deterioration of TB mortality (9). The sustainable development goals of the WHO and World Bank defined "universal health coverage" as universal access to the health services they need (10), which included basic prevention, treatment, and care interventions.…”

Toward a conceptual framework of the acceptability of tuberculosis treatment in children using a theory generative approach

“…Improving TB treatment acceptability for children and adolescents is increasingly recognised as a global health priority, as poor acceptability of treatment for prevention and treatment along the TB care cascade, may increase the risk of loss-to-follow-up (LTFU) and adversely affect treatment outcomes [5,6]. Research suggests losses along the TB treatment continuum of 10.8-20.0% among children and unfavourable outcomes of 10-17% [7][8][9][10][11]. No research to date, describes the associations between treatment acceptability and LTFU and children's health outcomes.…”