Date of Conferral

2021

Degree

Ph.D.

School

Public Health

Advisor

German G. Gonzalez

Abstract

Globally, Uganda is one of the 30 tuberculosis (TB) and human immunodeficiency virus (HIV) high burden countries with high antiretroviral therapy (ART) coverage, yet mortality is still high among TB/HIV patients on ART. The reasons for the high mortality have not been fully explored. The purpose of this study was to determine the association between multimorbidity, age, sex, marital status, phase of TB treatment, timing of initiation for ART, and type of TB and mortality among TB/HIV patients on ART in Uganda. The health outcomes conceptual framework with 3 domains that directly or indirectly affect the outcome domain was used to guide the study. A quantitative cross-sectional study design was used. The target population of 3,850 deidentified TB/HIV patients on ART, and data were abstracted from 2017, 2018, and 2019 medical records in 9 out of 14 systematically selected regional hospitals in Uganda. Descriptive analysis and binary logistics regression were conducted. TB/HIV patients on ART with 1 or 2 or more multimorbidity were 1.658 times and 1.901 times more likely to die than patients with no multimorbidity. TB/HIV patients on ART who were separated/divorced or single were 1.591 and 1.381 times more likely to die than married patients. The TB/HIV patients on ART who began ART treatment after TB treatment were 1.899 times more likely to die than patients who started ART before TB. The results can support social change by raising awareness among policymakers, national TB program staff, and health workers to implement approaches like patient-family-centered care to prevent deaths among TB/HIV patients on ART.

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