Factors influencing the uptake of tuberculosis preventive therapy (TPT) among female (18-49 years) household contacts of bacteriologically confirmed TB patients in Wakiso District, Uganda.

Abstract

Introduction: Tuberculosis (TB) remains a leading cause of morbidity and mortality in Uganda, with household contacts of bacteriologically confirmed TB patients facing heightened risk of infection. Although Tuberculosis Preventive Therapy (TPT) is an effective intervention, its uptake among adult female contacts remains suboptimal. In particular, women of reproductive age face intersecting vulnerabilities that may influence their decision to initiate TPT. This study investigates individual, community, and health system factors influencing TPT uptake in Wakiso District, Uganda. Objective: To assess the factors influencing the uptake of TPT among female household contacts aged 18–49 years of bacteriologically confirmed TB patients in Wakiso District. Methodology: A mixed-methods cross-sectional study design was employed. Quantitative data were collected through structured interviews with 317 eligible women using a multistage sampling approach. Logistic regression analyses were used to identify associations between independent variables and TPT uptake. Qualitative data were gathered through four in-depth interviews with TB contacts purposively selected by health workers and community health personnel and analyzed thematically to contextualize the quantitative findings per objective. Results: TPT uptake among respondents was 76%. Key individual-level predictors of higher uptake included having primary or secondary education (AOR = 4.76; p = 0.018) and informal employment (AOR = 2.40; p = 0.025). At the community level, participants exposed to health talks or community health worker visits were more likely to initiate TPT, while stigma and fear of being mistaken for an active TB case remained deterrents. Among health system factors, women who experienced long wait times at health facilities (AOR = 2.26; p = 0.003) or medicine stockouts (AOR = 2.53; p = 0.022) paradoxically showed higher TPT initiation, suggesting persistence despite service inefficiencies. Qualitative insights highlighted the importance of supportive health worker interactions, privacy assurance, concern about side effects, and accessibility, with logistical barriers, such as transportation and stockouts, frequently cited. Conclusion: Despite relatively high TPT uptake, gaps remain due to educational, perceptual, and systemic barriers. Interventions to improve TPT coverage should focus on providing tailored health education, reducing stigma, and strengthening community-based delivery systems. Ensuring consistent medicine availability and enhancing provider-client relationships can significantly improve adherence and retention in TPT programs among women in high TB burden settings.