Conjoint alcohol and tobacco use among tuberculosis patients in public primary healthcare in South Africa

Objective. To determine the prevalence of, and factors associated with conjoint alcohol and tobacco use among tuberculosis (TB) patients in South Africa (SA). Methods. In a cross-sectional survey, 4 900 (54.5% men, 45.5% women) consecutively selected TB patients (including new TB and new TB retreatment patients) from 42 public primary care clinics in three districts in SA were assessed using various measures (including those for alcohol and tobacco use), within one month of anti-TB treatment. Results. Overall, 10.1% (15.5% among men; 3.4% among women) were conjointly hazardous, harmful or dependent alcohol users and daily or almost-daily tobacco users. The proportion of daily or almost-daily tobacco users among hazardous, harmful or dependent alcohol users was 48.9%, (53.3% among men; 26.4% among women). Those with hazardous, harmful or dependent alcohol use had significantly higher odds of having anxiety and/or depression (odds ratio (OR) 1.37; confidence interval (CI) 1.13 - 1.65) and exhibiting daily or almost-daily tobacco use (OR 5.94; CI 4.33 - 5.87). The mean ± standard deviation alcohol use disorders identification test (AUDIT) score among conjoint hazardous, harmful or dependent alcohol users and daily or almost-daily tobacco users was significantly higher (17.1 ± 6.1) than among hazardous, harmful or dependent alcohol users who were not current tobacco users (15.4±5.6) (p<0.001). In multivariate analysis, male gender, coloured ethnicity, lower education and greater poverty, TB retreatment patient status and non-adherence to anti-TB medication were associated with a greater risk for conjoint alcohol and tobacco use. Conclusions. A high prevalence and several risk factors for conjoint alcohol and tobacco use were found among TB patients. The findings of this study call for dual-intervention approaches to alcohol and tobacco use.