The effect of concurrent mental illness on tuberculosis treatment outcomes at Butabika National Referral Mental Hospital – Uganda

Abstract

Background The renaissance of tuberculosis (TB) through certain groups of the population including patients with mental illness has been observed for the last 30 years. However, literature on treatment outcomes of patients with mental illness is still scarce. The following research examines the impact of concurrent mental health illness on TB treatment outcomes in Butabika National Referral Mental Hospital. Methods A retrospective analysis of data for registered TB patients with and without mental-illness for the period July 2013 to December 2015. Data was extracted for age, sex, human immunodeficiency virus (HIV) serostatus and Directly Observed Treatment (DOT) status, TB classification and history of TB treatment. For HIV co-infected patients, data on Co-trimoxazole preventative therapy (CPT) and anti-retroviral therapy (ART) uptake was collected. Treatment outcomes of patients with and without mental illness were analyzed. Results A total of 325 records were analyzed, of which 105 (32%) patients were found to have had mental illness. Of the patients with mental illness, 61 (58%) were HIV positive while of those without mental illness, 134 (61%) were HIV positive. Patients with mental illness were less likely to complete treatment (adj. OR 0.3, 95% CI 0.2 - 0.5, p = 0.000) more likely to die, (adj. OR 2.3, 95% CI 1.2 – 4.3, p = 0.01) and more likely to get lost to follow up during treatment (adj. OR 2.8, 95% CI 1.3 – 6.0, p = 0.005) compared to those without mental illness. Conclusion Mental illness is associated with unfavorable outcomes of TB treatment. We recommend targeted interventions for patient follow up at this hospital and further studies to guide improvement in the quality care in this patient population. We also recommend psychosocial assessment and counselling for all patients on TB treatment as practice to improve treatment outcomes for all TB patients in Kampala.