Understanding patient-reported reasons for tuberculosis treatment interruption in Central Uganda: a qualitative study

Abstract

Despite being a curable disease, tuberculosis (TB) remains a major public health problem in low-resource settings, including Uganda, which is among the World Health Organization’s high TB/HIV burden countries. Suboptimal treatment success rates persist, largely driven by treatment interruption and loss to follow-up. While existing evidence has focused largely on programmatic and provider perspectives, limited data exist on patient-reported reasons for TB treatment interruption in Uganda. This study explored patients’ perspectives on factors contributing to TB treatment interruption and identified patient-suggested strategies to improve adherence. A qualitative descriptive study was conducted among TB patients who missed at least one clinic appointment or treatment refill between January and March 2021 at nine purposively selected high-volume public health facilities in central Uganda. Participants were purposively sampled from TB clinic registers to ensure inclusion of individuals with lived experience of treatment interruption. Face-to-face interviews were conducted using structured guides to elicit experiences, perceptions, and contextual factors influencing adherence. Interviews were audio-recorded, transcribed verbatim, and analyzed using inductive (data-driven) thematic analysis, with themes derived through iterative coding following the approach described by Braun and Clarke. Thirty-four TB patients (61.8% male; mean age 38.9 years, range 19–80) participated. Barriers to adherence included medication side effects, stigma, transport and food insecurity, COVID-19–related restrictions, and health system challenges such as negative provider attitudes, long waiting times, inadequate counseling, poor communication, and inflexible services. Forgetfulness, travel without enough medication, and clinic closures further contributed to missed appointments and doses. Facilitators included strong motivation to regain health, use of reminders, social and treatment supporter assistance, prior treatment experiences, and integration of TB and HIV services. Participants recommended socioeconomic support, decentralized and flexible drug refill systems, appointment reminders, improved patient–provider communication, and strengthened peer and treatment supporter mechanisms. From the patient perspective, TB treatment interruption is attributed to interconnected patient, socioeconomic, and health system barriers and can be mitigated through patient-centered support. TB programs should prioritize flexible, decentralized care and strengthen adherence support and patient–provider communication.