Health Service Delivery Factors Influencing Drug-resistant Tuberculosis Treatment Outcomes in Meru County, Kenya

Abstract

Background: Despite substantial progress in the management of drug-resistant tuberculosis (DR-TB) through the introduction of all-oral treatment regimens, unfavourable treatment outcomes remain a major challenge in high-burden settings. Beyond patient and clinical characteristics, health service delivery factors play a critical role in determining treatment success by influencing continuity of care, treatment adherence, and timely clinical monitoring. However, evidence on the contribution of health service delivery factors to DR-TB treatment outcomes in Kenya remains limited. This study examined the influence of health service delivery factors on treatment outcomes among patients receiving DR-TB treatment in Meru County, Kenya. Methods: A retrospective descriptive study was conducted using routinely collected TB programme data from 201 patients diagnosed with DR-TB and initiated treatment between January 2020 and December 2023 across 11 sub-counties in Meru County. Data on health service delivery characteristics, including frequency of clinical review, treatment support, type of treatment facility, and treatment delivery model, were extracted from patient records. Descriptive statistics summarised patient characteristics and treatment outcomes, while chi-square tests and multivariable logistic regression were used to determine associations between health service delivery factors and treatment outcomes. Statistical significance was set at p < .05. Results: Overall, 173 (86%) patients were cured, 18 (9%) completed treatment, 6 (3%) were lost to follow-up, and 4 (2%) died during treatment. In the multivariable analysis, none of the assessed health service delivery factors was independently associated with treatment outcomes: frequency of clinical reviews (OR = 0.32, 95% CI = 0.06–1.81; p = 0.197), laboratory monitoring (OR = 0.72, 95% CI = 0.17–3.10; p = 0.654), X-ray services (OR = 0.96, 95% CI = 0.22–4.14; p = 0.954), and model of care (OR = 1.59, 95% CI = 0.41–6.11; p = 0.498). Conclusions: The cohort had a high cure proportion, but none of the assessed health service delivery factors independently predicted treatment outcome in the adjusted model. Routine clinical monitoring and structured follow-up remain important components of DR-TB care, although the present analysis does not support attributing treatment success to a single measured service-delivery factor. Further research should assess the contribution of patient, clinical, and wider health-system characteristics to DR-TB outcomes in comparable settings.