Date of Conferral

5-21-2025

Date of Award

May 2025

Degree

Doctor of Public Health (DrPH)

School

Health Services

Advisor

Peter Anderson

Abstract

While males are recognized as key drivers of tuberculosis (TB) transmission, the association between comorbidities (i.e., diabetes and malnutrition), adverse drug reactions (ADRs), and health system factors (i.e., frequency of drug refills) with TB treatment interruption, remains unclear. I aimed to determine the association between these factors and TB treatment interruption among males diagnosed with TB in Nairobi County, Kenya controlling for age, sub-county of residence, alcohol use, HIV co-infection, type of TB and presence of treatment supporter. Guided by WHO’s framework on adherence to long-term therapies, a quantitative, case-control study was conducted using secondary analysis of Kenya’s TB surveillance data. Logistic regression analysis assessed associations between treatment interruption and comorbidities (i.e., diabetes, malnutrition), therapy-related factors (ADRs), and health system-related factors (i.e., frequency of drug refills), adjusting for key covariates. The findings revealed that malnutrition and ADRs were significantly associated with TB treatment interruption, while higher frequency of clinic visits for sputum tests and drug refills were negatively associated. Additionally, alcohol use, subcounty of residence, and pulmonary TB were significant predictors of treatment interruption. These findings underscore the need for targeted nutritional support, enhanced management of ADRs, and strengthened health system strategies to improve adherence to TB treatment among men. Addressing these factors through patient-centered interventions and health system improvements could reduce treatment interruptions and improve TB outcomes in Nairobi County, positively impacting individuals, families, and communities.

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