Socio-Economic Determinants of Tuberculosis Treatment Outcomes and the Role of Community Engagement in Strengthening TB Care in Rural Settings

Background: Tuberculosis (TB) remains a major public health challenge in many low- and middle-income countries, where socio-economic inequalities continue to undermine treatment success. Structural barriers such as poverty, unemployment, and limited access to healthcare services can disrupt treatment adherence and contribute to poor outcomes. While biomedical interventions remain central to TB control, there is growing recognition that community engagement strategies may strengthen TB management. This study examined the influence of socio-economic determinants on TB treatment outcomes and explored the potential contribution of community engagement interventions to improving TB care in rural settings. Methods: A retrospective quantitative analysis was conducted using a dataset of 512 patient records with documented TB treatment outcomes. Descriptive statistics were used to summarise patient characteristics. Multivariable logistic regression was applied to identify socio-economic determinants associated with unsuccessful treatment outcomes. Scenario-based predictive modelling and marginal effects analysis were then used to estimate the potential impact of integrating community engagement mechanisms, including community health worker outreach, peer support networks, and community-based health education. Results: Overall, 79.1% of patients achieved successful treatment outcomes, while 17.0% experienced unsuccessful outcomes. Social vulnerability was strongly associated with poor treatment outcomes (AOR = 1.8; 95% CI: 1.2–2.6). Unemployment (AOR = 1.6; 95% CI: 1.1–2.3) and unstable income sources (AOR = 1.5; 95% CI: 1.0–2.2) were also significant predictors of unsuccessful outcomes. Predictive modelling suggested that integrating community engagement interventions could reduce the predicted probability of unsuccessful treatment outcomes from 17% to approximately 10%. Interaction analysis further indicated that the greatest improvements occurred among patients with high socio-economic risk. Conclusion: Socio-economic vulnerability remains a critical determinant of TB treatment outcomes. Integrating community engagement strategies, particularly community-based health education and patient support mechanisms, may improve treatment adherence and reduce unsuccessful outcomes, especially among socially disadvantaged populations. Strengthening community participation in TB programmes may therefore represent an important pathway toward more equitable and effective TB control. Keywords: tuberculosis; community engagement; socio-economic determinants; treatment outcomes; health education; rural health; predictive modelling.