Hidden in Success: Gendered Patterns of Suboptimal Care Engagement Among TB Patients Who "Successfully" Completed...

Adherence to tuberculosis (TB) treatment is key to optimal health outcomes. Programmatic definitions of treatment success may mask heterogeneity in care engagement patterns that increase risk of unfavorable outcomes.

Using patient-level medication refill data, latent-class growth modelling was used to identify longitudinal trajectories of care engagement among participants who programmatically achieved treatment success. Logistic regression was conducted to investigate participant-level characteristics associated with trajectory class membership.

Among 548 participants, we identified three trajectories: Class 1 (consistent engagement; 84.1%), Class 2 (suboptimal engagement after 2 months; 7.7%) and Class 3 (suboptimal engagement from initiation; 8.2%). At treatment completion, Classes 1-3 accumulated 9.7 (95% CI: 7.4-11.8), 68.4 (60.4-76.9) and 55.5 (48.1-62.7) missed refill days, respectively. In gender-stratified models, men exhibited all three trajectories (83.1%, 7.4%, and 9.5%, respectively), and accumulated 10.6 [7.8-13.3], 61.0 [50.2-71.3], 53.3 [53.3-71.4] missed refill days, respectively. Women exhibited only Classes 1 and 3 (89.5% and 10.5%, respectively) and accumulated 12.1 [7.8-16.5] and 46.9 [33.3-61.6] missed refill days, respectively. Among men, prior TB (Class 2: aOR 7.44, 2.79-19.8; Class 3: aOR 2.78, 1.07-7.25) and HIV-negative status (Class 3: aOR 2.72, 1.13-6.54) were associated with suboptimal trajectories. Among women, prior TB was associated with suboptimal engagement (aOR 5.22, 1.11-24.44).

Programmatic Treatment Success obscured suboptimal engagement trajectories. Patient-centered counseling and gender-responsive interventions are needed to address suboptimal engagement across treatment stages. Shorter treatment regimens will unlikely resolve suboptimal engagement, underscoring the importance of regimen forgiveness.