Date of Conferral

1-23-2026

Date of Award

January 2026

Degree

Ph.D.

School

Health Sciences

Advisor

German Gonzalez

Abstract

There are unsuccessful treatment outcomes with Tuberculosis (TB) disease, although effective therapies exist. This study aimed to identify predictors of unsuccessful treatment using the socioecological model. A quantitative cross-sectional study and multinomial logistic regression analysis were used to measure the associations between long-term care (LTC), homelessness, correctional facility, Human Immunodeficiency Virus (HIV), diabetes, excess alcohol, illicit drug use, and TB treatment outcomes of death, lost to follow-up, and treatment refusal. The sample consisted of 7,589 individuals aged 15 and older with pulmonary TB between 2017 and 2021, residing in California, Ohio, and Maryland. Findings indicated a correlation between community factors (LTC, homelessness, correctional facility), individual factors (HIV, illicit drugs), and TB treatment outcomes. Homelessness was a predictor of death (Exp(B)=1.75, 95% CI :1.24-2.48, p=.001), loss to follow-up (Exp(B)=4.55,95% CI: 2.82-7.33; p<.001) and treatment refusal (Exp(B)=3.24,95% CI:1.42-7.37, p=.005). Positive HIV was associated with death (Exp(B)=2.10,95% 1.24-3.56,p =.005). The results of this study will inform stakeholders about the risk factors for unsuccessful treatment outcomes and lead to positive social change by improving treatment outcomes for populations experiencing disparities.

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