Patient and Provider Perceptions of the Relationship Between Alcohol Use and TB and Readiness for Treatment: a Qualitative Study in South Africa

Overview

Journal Res Sq

Date 2023 Oct 16

PMID 37841852

Authors

Suchitra Kulkarni

Sarah E Weber

Chane Buys

Tersius Lambrechts

Bronwyn Myers

Mari-Lynn Drainoni

Karen R Jacobson

Danie Theron

Tara Carney

Affiliations

Soon will be listed here.

Abstract

Background: Unhealthy alcohol use is widespread in South Africa and has been linked to tuberculosis (TB) disease and poor treatment outcomes. This study used qualitative methods to explore the relationship between TB and alcohol use during TB treatment.

Methods: Focus groups (FGs) were conducted with 34 participants who had previous or current drugsusceptible TB and self-reported current alcohol use. Eight interviews were conducted with healthcare workers who provide TB services in Worcester, South Africa.

Results: In this rural setting, heavy episodic drinking is normalized and perceived to be related to TB transmission and decreased adherence to TB medication. Both healthcare workers and FG participants recommended the introduction of universal screening, brief interventions, and referral to specialized care for unhealthy alcohol use. However, participants also discussed barriers to the provision of these services, such as limited awareness of the link between alcohol and TB. Healthcare workers also specified resource constraints while FG participants or patients mentioned widespread stigma towards people with alcohol concerns. Both FG participants and health providers would benefit from education on the relationship between TB and unhealthy alcohol use as well and had specific recommendations about interventions for alcohol use reduction. Healthcare workers also suggested that community health worker-delivered interventions could support access to and engagement in both TB and alcohol-related services.

Conclusion: Findings support strengthening accessible, specialized services for the identification and provision of interventions and psychosocial services for unhealthy alcohol use among those with TB.

References

Silva D, Munoz-Torrico M, Duarte R, Galvao T, Bonini E, Arbex F . Risk factors for tuberculosis: diabetes, smoking, alcohol use, and the use of other drugs. J Bras Pneumol. 2018; 44(2):145-152. PMC: 6044656. DOI: 10.1590/s1806-37562017000000443. View

Watermeyer J, Penn C . Community perspectives on tuberculosis care in rural South Africa. Health Soc Care Community. 2018; 27(1):182-190. DOI: 10.1111/hsc.12637. View

Volkmann T, Moonan P, Miramontes R, Oeltmann J . Tuberculosis and excess alcohol use in the United States, 1997-2012. Int J Tuberc Lung Dis. 2014; 19(1):111-9. PMC: 4798229. DOI: 10.5588/ijtld.14.0516. View

Chaulk C, Moonan P . Over the limit: tuberculosis and excessive alcohol use. Int J Tuberc Lung Dis. 2020; 24(1):3-4. PMC: 7347243. DOI: 10.5588/ijtld.19.0325. View

Hayes-Larson E, Hirsch-Moverman Y, Saito S, Frederix K, Pitt B, Maama-Maime L . Depressive symptoms and hazardous/harmful alcohol use are prevalent and correlate with stigma among TB-HIV patients in Lesotho. Int J Tuberc Lung Dis. 2017; 21(11):34-41. PMC: 5776389. DOI: 10.5588/ijtld.17.0062. View

Louwagie G, Morojele N, Siddiqi K, Mdege N, Tumbo J, Omole O . Addressing tobacco smoking and drinking to improve TB treatment outcomes, in South Africa: a feasibility study of the ProLife program. Transl Behav Med. 2019; 10(6):1491-1503. DOI: 10.1093/tbm/ibz100. View

Lonnroth K, Williams B, Stadlin S, Jaramillo E, Dye C . Alcohol use as a risk factor for tuberculosis - a systematic review. BMC Public Health. 2008; 8:289. PMC: 2533327. DOI: 10.1186/1471-2458-8-289. View

Calligaro G, de Wit Z, Cirota J, Orrell C, Myers B, Decker S . Brief psychotherapy administered by non-specialised health workers to address risky substance use in patients with multidrug-resistant tuberculosis: a feasibility and acceptability study. Pilot Feasibility Stud. 2021; 7(1):28. PMC: 7814702. DOI: 10.1186/s40814-020-00764-1. View

Regenauer K, Kleinman M, Belus J, Myers B, Joska J, Magidson J . Effects of intersecting internalized stigmas and avoidance on HIV and alcohol-related outcomes among people living with HIV in South Africa. Drug Alcohol Depend. 2022; 233:109364. PMC: 8978067. DOI: 10.1016/j.drugalcdep.2022.109364. View

10.

Mishra P, Sharma R, Yadav R, Rao V, Nigam S, Lingala M . Reasons for loss to follow-up (LTFU) of pulmonary TB (PTB) patients: A qualitative study among Saharia, a particularly vulnerable tribal group of Madhya Pradesh, India. PLoS One. 2021; 16(12):e0261152. PMC: 8699669. DOI: 10.1371/journal.pone.0261152. View

11.

Ragan E, Kleinman M, Sweigart B, Gnatienko N, Parry C, Horsburgh C . The impact of alcohol use on tuberculosis treatment outcomes: a systematic review and meta-analysis. Int J Tuberc Lung Dis. 2020; 24(1):73-82. PMC: 7491444. DOI: 10.5588/ijtld.19.0080. View

12.

Magidson J, Lee J, Johnson K, Burnhams W, Koch J, Manderscheid R . Openness to adopting evidence-based practice in public substance use treatment in South Africa using task shifting: Caseload size matters. Subst Abus. 2017; 39(2):162-166. PMC: 5862765. DOI: 10.1080/08897077.2017.1380743. View

13.

Louwagie G, Kanaan M, Morojele N, van Zyl A, Moriarty A, Li J . Effect of a brief motivational interview and text message intervention targeting tobacco smoking, alcohol use and medication adherence to improve tuberculosis treatment outcomes in adult patients with tuberculosis: a multicentre, randomised.... BMJ Open. 2022; 12(2):e056496. PMC: 8845202. DOI: 10.1136/bmjopen-2021-056496. View

14.

Myers B, Bouton T, Ragan E, White L, McIlleron H, Theron D . Impact of alcohol consumption on tuberculosis treatment outcomes: a prospective longitudinal cohort study protocol. BMC Infect Dis. 2018; 18(1):488. PMC: 6162918. DOI: 10.1186/s12879-018-3396-y. View

15.

Duarte R, Lonnroth K, Carvalho C, Lima F, Carvalho A, Munoz-Torrico M . Tuberculosis, social determinants and co-morbidities (including HIV). Pulmonology. 2017; 24(2):115-119. DOI: 10.1016/j.rppnen.2017.11.003. View

16.

Bhana A, Rathod S, Selohilwe O, Kathree T, Petersen I . Characteristics and correlates of alcohol consumption among adult chronic care patients in North West Province, South Africa. S Afr Med J. 2017; 107(7):636-642. DOI: 10.7196/SAMJ.2017.v107i7.12131. View

17.

Parry C, Gossage J, Marais A, Barnard R, de Vries M, Blankenship J . COMPARISON OF BASELINE DRINKING PRACTICES, KNOWLEDGE, AND ATTITUDES OF ADULTS RESIDING IN COMMUNITIES TAKING PART IN THE FAS PREVENTION STUDY IN SOUTH AFRICA. Afr J Drug Alcohol Stud. 2014; 11(2):65-76. PMC: 4225715. View

18.

Tong A, Sainsbury P, Craig J . Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007; 19(6):349-57. DOI: 10.1093/intqhc/mzm042. View

19.

Myers B, Louw J, Pasche S . Inequitable access to substance abuse treatment services in Cape Town, South Africa. Subst Abuse Treat Prev Policy. 2010; 5:28. PMC: 2992042. DOI: 10.1186/1747-597X-5-28. View

20.

Peltzer K, Louw J, Mchunu G, Naidoo P, Matseke G, Tutshana B . Hazardous and harmful alcohol use and associated factors in tuberculosis public primary care patients in South Africa. Int J Environ Res Public Health. 2012; 9(9):3245-57. PMC: 3499864. DOI: 10.3390/ijerph9093245. View