Correlates of adherence to tuberculosis treatment among patients in Igembe North, Meru County, Kenya

Tuberculosis (TB) remains a major public health concern globally, with suboptimal treatment adherence contributing to continued transmission, morbidity, and mortality. This study assessed factors associated with adherence to TB treatment among adult patients in Igembe North Sub-County, Meru County, Kenya. The Health Belief Model (HBM) is the foundational theoretical framework used to elucidate the determinants of health-related behaviors and treatment adherence. An analytical cross-sectional study design was employed involving 197 patients aged 18 years and above who were receiving TB treatment across 10 purposively selected health facilities. Participants were selected using proportional allocation and systematic random sampling. Data was collected using an interviewer-administered structured questionnaire, and adherence was measured using the Morisky Medication Adherence Scale (MMAS-8). Data was analyzed using Statistical Package for Social Sciences (SPSS) version 26. Descriptive statistics summarized adherence levels, while chi-square tests assessed associations between independent variables and adherence. Overall, 46% of respondents demonstrated moderate adherence, 37% poor adherence, and 17% good adherence. Marital status was significantly associated with adherence (χ² = 20.421, p = 0.002), with married individuals more likely to adhere compared to separated individuals. Knowledge of TB transmission was also significantly associated with adherence (χ² = 40.395, p < 0.001). Health service delivery factors, particularly healthcare provider attitude, showed a strong association with adherence (χ² = 27.777, p < 0.001). Substance use, including smoking (χ² = 18.433, p < 0.001) and alcohol consumption (χ² = 19.811, p < 0.001), was significantly associated with poor adherence. Medicine-related factors, especially perceived impact of side effects, demonstrated a strong association with adherence (χ² = 66.496, p < 0.001). Adherence to TB treatment in this setting remains suboptimal and is influenced by socio-demographic, patient-related, health system, and treatment-related factors. Interventions should prioritize patient education, strengthening provider–patient interactions, and integrated psychosocial and nutritional support to improve adherence outcomes.