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Objective: The objective of this study is to investigate the effect of food insecurity on the mental health of patients with tuberculosis (TB) in Ethiopia., Design: A prospective cohort study., Setting: Health centres and hospitals located in Jimma zone, Southwest Ethiopia., Participants: Patients with TB who had recently been diagnosed with TB and started directly observed treatment in the selected 26 health institutions from October 2017 to October 2018. A total of 268 patients were followed for 6 months and data were collected at recruitment and two follow-up visits (at 2 and 6 months). Patients with multidrug-resistant TB were not included in the study., Main Outcome Measures: Mental distress was measured by the Self-Reporting Questionnaire-20 while food insecurity was assessed by using the Household Food Insecurity Access Scale., Results: A total of 268 patients were recruited and there was no lost to follow-up. The prevalence of food insecurity at baseline, first and second follow-up was 49.3%, 45.9% and 39.6%, respectively. Of these, 28.0% of them reported severe food insecurity at baseline which declined to 23.5% at the end of the sixth month. Likewise, the prevalence of mental distress at baseline was 61.2% but declined to 22.0% at the second follow-up. At baseline, 77.3% of patients with mental distress reported severe food insecurity but declined to 46.0% at second follow-up. In the final model, severe food insecurity (OR 4.7, 95% CI 2.4 to 9.4) and being a government employee (adjusted odds ratio (aOR) 0.3, 95% CI 0.1 to 0.9) were associated with mental distress., Conclusion: In this study, food insecurity was associated with mental distress over the course of follow-up. Likewise, there is a high prevalence of food insecurity and mental distress among patients with TB on treatment. Therefore, early assessment and interventions for food insecurity may improve the mental health of patients with TB on treatment., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: In Ethiopia, little is known about the association between substance use disorders and adherence to antituberculosis (anti-TB) medications. Therefore, the objective of this study was to assess the effect of substance use disorders on adherence to anti-TB medications in Southwest Ethiopia., Design: Prospective cohort study., Settings: Patients were recruited from 22 health centres and four hospitals in Southwest Ethiopia., Participants: This study was conducted among 268 patients with TB, aged 18-80 in Southwest Ethiopia between October 2017 and October 2018. At baseline, patients who were exposed substance use disorders (134 patients) and unexposed to substance use disorders (134 patients) were recruited. Patients were followed for 6 months, and data were collected on three occasions., Main Outcome Measure: Adherence to anti-TB medications., Results: Patients with substance use disorders had consistently higher prevalence of non-adherence than those without, 16.4% versus 3.0% at baseline, 41.7% versus 14.4% at 2-month follow-up and 45.7% versus 10.8% at 6-month follow-up assessments. Patients with khat use disorder were 3.8 times more likely to be non-adherent to anti-TB medications than patients without khat use disorder (Adjusted odds ratio (aOR)=3.8, 95% CI 1.8 to 8.0). Patients who had alcohol use disorder (AUD) were also 3.2 times likely to have poor adherence compared with their counterparts (aOR=3.2, 95% CI 1.6 to 6.6). In addition, being educated (aOR=4.4, 95% CI 1.7 to 11.3), and being merchant (aOR=6.1, 95% CI 1.2 to 30.8) were associated with non-adherence to anti-TB medications., Conclusion: Khat and AUDs predict greater likelihood of non-adherence to anti-TB medication. This implies the need to integrate the management for substance use disorders into the existing TB treatment services., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Tuberculosis (TB) is a leading cause of morbidity and mortality in low and middle-income countries. Substance use negatively affects TB treatment outcomes. Our recent study has found that khat use predicted poorer adherence to anti-TB medications. However, there is scarce longitudinal study on predictors of khat use among outpatients with TB, and this study aimed at addressing this research gap., Methods: From October 2017 to October 2018, 268 outpatients with tuberculosis on DOTs were enrolled in a longitudinal study from 26 health institutions in Southwest Ethiopia. Structured questionnaires translated into local languages (Afaan Oromoo and Amharic) were used to assess khat use. Patients were followed for six months, and data were collected on three occasions during the follow-up. A generalized linear mixed model was used to identify the relation between khat use and predictors. Model fitness was checked using the Bayesian Information Criterion (BIC). Odds ratio (OR) and 95% CI were used to describe the strength of association between the outcome variable and predictors., Results: The overall prevalence of khat use at baseline and first follow up was 39.2% while it was 37.3% at second follow up. Of this, 77.1% and 96.2% of them believed that khat use reduces the side effects of anti-TB medications and symptoms of tuberculosis respectively. In the final model, being male (aOR = 7.0, p-value = 0.001), being government employee (aOR = 0.03, p-value≤0.001) and presence of alcohol use disorders (AUD) (aOR = 2.0, p-value≤0.001) predicted khat use among outpatients with tuberculosis., Conclusion: A considerable proportion of patients with TB used khat throughout DOTs and wrongly perceived that it had health benefits. The finding implies that all patients diagnosed with TB should be screened for khat use, and a particular emphasis should be given to males and individuals with a history of alcohol use. Moreover, further studies are needed to assess patients' beliefs regarding the benefits of khat use so that interventions can be developed., Competing Interests: The authors have declared that no competing interests exist.