Date of Conferral

10-2-2026

Date of Award

October 2026

Degree

Doctor of Public Health (DrPH)

School

Health Sciences

Advisor

Jamuir Robinson

Abstract

Tuberculosis (TB) cases have resurged in Virginia, yet the structural determinants shaping treatment completion among socioeconomically marginalized populations remain unquantified locally, leaving public health programs without state-specific predictive evidence. Grounded in the World Health Organization's social determinants of health framework, this quantitative, ex post facto study examined how employment status, housing stability, and social risk factors predicted TB treatment completion. De-identified surveillance records for N = 898 adult TB cases reported from 2020 through 2024 were extracted from the Virginia Electronic Disease Surveillance System and analyzed using a multivariable binary logistic regression, controlling for age, sex, race/ethnicity, and radiographic severity under Bonferroni-adjusted α = .0125. Adults experiencing homelessness prior to diagnosis had 69% lower adjusted odds of completing treatment than stably housed peers (AOR = 0.31, 95% CI [0.13, 0.74], p = .009). Unemployment (AOR = 0.43, p = .013) and non-wage-earning status also substantially reduced the odds of treatment completion. In joint modeling, housing instability (AOR = 0.27, p = .005) and employment detachment persisted as independent, parallel predictors. Within the social risk block, heavy alcohol use was a potent individual risk factor. Four field-based products translate these findings: a policy brief, an intervention plan, an operational framework, and an educational fact sheet. This study contributes to positive social change by informing Virginia health districts about housing and employment barriers and supporting targeted screening and services that promote tuberculosis treatment completion and reduce community transmission.

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