An Investigation into the Prevalence and Determinants of TB Treatment Default in Lubumbashi Health Zone, DRC, 2024

Abstract

Tuberculosis (TB) remains a major public health concern in the Democratic Republic of the Congo (DRC), particularly in urban areas such as Lubumbashi. This study examined the prevalence and determinants of TB treatment default in the Lubumbashi Health Zone to inform targeted interventions. A mixed-methods design was employed, including a retrospective analysis of national TB register data and qualitative interviews with key stakeholders. Eligible participants had documented pre-treatment smear results in accordance with national guidelines. Treatment default was defined as an interruption of 30 to 60 consecutive days. Cases labeled "transferred out," "moved out," "died," or "failed" were excluded. Logistic regression identified quantitative risk factors, while thematic analysis explored patient experiences. The treatment default rate was 69.0%, with higher risk observed among males, individuals aged 25–44, those with lower education levels, and workers in the informal sector. Socioeconomic challenges, including low income and lack of healthcare benefits, along with stigma and discrimination, were significant contributors to default. In contrast, greater TB knowledge and positive attitudes toward treatment were associated with higher adherence. Most defaults occurred within the first month of treatment. The findings underscore the urgent need for financial and social support, improved access to care, and patient-centered education to enhance treatment adherence and reduce TB-related morbidity and transmission in Lubumbashi.