Multilevel Determinants of Tuberculosis Treatment Completion in a High-Burden District of South Africa: A Mixed-Methods Study
1
Health Programs, Eastern Cape Department of Health, Bhisho, South Africa
2
Health Science, Foundation for Professional Development, Pretoria, South Africa
3
NPO, Best Health Solutions, Johannesburg, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A593
ABSTRACT
BACKGROUND:
Tuberculosis (TB) remains a major public health challenge despite being curable. Treatment interruption and loss to follow-up continue to undermine TB control efforts, contributing to ongoing transmission and the development of drug resistance, particularly in high-burden settings.1,2,3 This study examines the factors influencing TB treatment completion in the Buffalo City Metropolitan (BCM) Health District, Eastern Cape, South Africa, with the aim of identifying key facilitators and barriers that enhance or hinder treatment completion among TB patients.
METHODS:
A mixed-methods study design was employed. Quantitative data were obtained from routine health information systems, including the District Health Information System (DHIS) and TIER.Net, as well as patient questionnaires. Qualitative data were collected through in-depth interviews with TB patients receiving care at selected high-burden facilities within BCM. Quantitative data were analysed using descriptive and inferential statistical methods, while qualitative data were analysed thematically. Integration of findings from both components allowed for a comprehensive understanding of the factors influencing TB treatment completion.
RESULTS:
TB treatment completion was influenced by multiple, interrelated factors. Socio-demographic characteristics such as age, gender, and level of education were found to affect treatment adherence. Patient-related barriers included stigma, financial constraints, and limited knowledge of TB treatment. Healthcare service-related factors, particularly poor communication between healthcare providers and patients and the complexity of treatment regimens, further hindered treatment completion. In contrast, lifestyle and behavioural factors, especially strong family, and social support, emerged as important facilitators of adherence and sustained engagement in care.
CONCLUSIONS:
TB treatment completion in the BCM is shaped by a complex interaction of personal, social, lifestyle, and health system factors. The findings highlight the need for a coordinated, patient-centred approach that addresses both health system challenges and broader socio-economic barriers. Strengthening provider–patient communication, improving patient education, and reinforcing community-based support are critical strategies for improving treatment outcomes.
Tuberculosis (TB) remains a major public health challenge despite being curable. Treatment interruption and loss to follow-up continue to undermine TB control efforts, contributing to ongoing transmission and the development of drug resistance, particularly in high-burden settings.1,2,3 This study examines the factors influencing TB treatment completion in the Buffalo City Metropolitan (BCM) Health District, Eastern Cape, South Africa, with the aim of identifying key facilitators and barriers that enhance or hinder treatment completion among TB patients.
METHODS:
A mixed-methods study design was employed. Quantitative data were obtained from routine health information systems, including the District Health Information System (DHIS) and TIER.Net, as well as patient questionnaires. Qualitative data were collected through in-depth interviews with TB patients receiving care at selected high-burden facilities within BCM. Quantitative data were analysed using descriptive and inferential statistical methods, while qualitative data were analysed thematically. Integration of findings from both components allowed for a comprehensive understanding of the factors influencing TB treatment completion.
RESULTS:
TB treatment completion was influenced by multiple, interrelated factors. Socio-demographic characteristics such as age, gender, and level of education were found to affect treatment adherence. Patient-related barriers included stigma, financial constraints, and limited knowledge of TB treatment. Healthcare service-related factors, particularly poor communication between healthcare providers and patients and the complexity of treatment regimens, further hindered treatment completion. In contrast, lifestyle and behavioural factors, especially strong family, and social support, emerged as important facilitators of adherence and sustained engagement in care.
CONCLUSIONS:
TB treatment completion in the BCM is shaped by a complex interaction of personal, social, lifestyle, and health system factors. The findings highlight the need for a coordinated, patient-centred approach that addresses both health system challenges and broader socio-economic barriers. Strengthening provider–patient communication, improving patient education, and reinforcing community-based support are critical strategies for improving treatment outcomes.
| eISSN: | 2654-1459 |
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