Multidimensional Determinants of Tuberculosis Treatment Completion in GIDA Communities: A Mixed-Methods Analysis

Vollständiger Abstract

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Introduction: Tuberculosis (TB) treatment completion remains challenging in Geographically Isolated and Disadvantaged Areas (GIDAs), where geographic, social, and health-system barriers may disrupt continuity of care. Objective: This study examined individual, community, structural, and health-system factors associated with TB treatment completion in selected GIDA barangays of Pangantucan, Bukidnon, Philippines. Methods: An explanatory sequential mixed-methods design (QUAN → QUAL) was used. The quantitative phase combined retrospective review of treatment information with questionnaire data from 220 purposively selected participants. Data were analyzed using descriptive statistics and multivariable binary logistic regression. Open-ended qualitative responses from 25 participants were analyzed using inductive thematic analysis and integrated during interpretation. Results: Greater CHW engagement (OR = 1.51, 95% CI: 1.26–1.82), stronger family and social support (OR = 1.43, 95% CI: 1.17–1.76), and greater DOTS utilization (OR = 1.39, 95% CI: 1.18–1.63) were associated with higher odds of treatment completion, whereas poorer transportation access was associated with lower odds (OR = 0.75, 95% CI: 0.60–0.94). The model showed good discrimination (AUC = .819) but suboptimal calibration (Hosmer–Lemeshow χ² = 17.90, p = .012). Qualitative findings emphasized the roles of CHWs, family involvement, transportation barriers, financial constraints, stigma, and treatment-related concerns. Conclusion: TB treatment completion in GIDA communities is associated with interacting individual, community, structural, and health-system factors. Community-based follow-up, family-centered support, accessible DOTS services, and transportation assistance may strengthen treatment continuity.