Prevalence and associated factors of non-adherence to anti-tuberculosis treatment among patients receiving tuberculosis care in Southwestern Uganda

Abstract Background Tuberculosis (TB) remains a major public health challenge in Uganda despite the availability of effective treatment. Non-adherence to anti-TB medication continues to undermine national TB control efforts, contributing to treatment failure, drug resistance, prolonged infectiousness, and increased morbidity and mortality. Most Ugandan evidence on treatment adherence comes from national referral or urban public facilities, leaving adherence patterns at smaller, private not-for-profit facilities comparatively unexamined. Objective This study assessed the prevalence of non-adherence and its associated patient-related, therapy-related, and health-system factors among tuberculosis patients attending Ishaka Adventist Hospital in Bushenyi District, Uganda. Methods An analytical cross-sectional study was conducted among 152 adult TB patients who had been on treatment for at least three months, recruited consecutively from the TB clinic during the study period, August 2025 to December 2025. Data were collected using structured interviewer-administered questionnaires and TB treatment registers. For this analysis, non-adherence was defined as taking less than 80% of prescribed doses in the previous month. Bivariate screening (χ2/Fisher’s exact, p < 0.20) was followed by multivariable logistic regression to identify factors associated with non-adherence. Analyses were performed in IBM SPSS version 27. Results Of 152 enrolled patients, adherence could be determined for 151; the prevalence of non-adherence was 27.2% (41/151). Among the 81 patients who reported missing at least one dose, the most frequently cited reasons were forgetfulness (93.8%), being busy (39.5%), and side effects (39.5%). HIV was prevalent (53.9%, 82/152) but was not associated with non-adherence (χ² p = 0.580; mean adherence 87.2% in HIV-positive vs. 89.6% in HIV-negative participants, Mann-Whitney p = 0.384). No socio-demographic factor was significantly associated with non-adherence in the adjusted model. Pill burden was independently associated with non-adherence after adjustment for age (adjusted OR 2.35, 95% CI 1.04–5.32, p = 0.040). Conclusion Around one in four TB patients at this facility were non-adherent, and pill burden was the only factor independently associated with non-adherence after adjustment. Interventions that reduce perceived pill burden such as fixed-dose combinations, pillbox aids, and side-effect counselling may be a more targeted lever for improving adherence in this setting than broad socio-demographic targeting.