Abstract
Background: Tuberculosis (TB) remains a leading cause of morbidity and mortality worldwide, with the East African Community (EAC) bearing a disproportionate burden. Although standardized six month treatment regimens are widely available, interruptions—defined as missing 14 or more consecutive days—continue to undermine TB control by increasing relapse, transmission, and drug resistance.
Objective: This systematic review and meta analysis aimed to estimate the pooled prevalence of TB treatment interruption in the EAC and to synthesize evidence on its key determinants.
Methods: A comprehensive search of PubMed/MEDLINE, Embase, Scopus, Web of Science, CINAHL, the Cochrane Library, African Journals Online, ProQuest, and grey literature was performed for studies published between January 2011 and August 2025. We included observational studies of adult TB patients from EAC countries. Study selection followed PRISMA guidelines, and quality was appraised using the Newcastle–Ottawa Scale. A random effects meta analysis was conducted to calculate the pooled prevalence, and heterogeneity was quantified with the I² statistic.
Results: Thirteen studies met the inclusion criteria. The pooled prevalence of TB treatment interruption across the region was 17 % (95 % CI: 15 %–20 %), with substantial heterogeneity (I² = 99.68 %). Prevalence varied by country, from 10 % in Rwanda to 35 % in Somalia. Determinants of interruption were multifactorial. Socio economic drivers included unemployment, poverty, and lower educational attainment. Health system barriers comprised long waiting times, drug stock outs, distance to facilities, and negative provider–patient interactions. Clinical factors such as HIV co infection, prior loss to follow up, TB relapse, adverse drug reactions, and intensive phase treatment predicted interruptions. Behavioral contributors involved alcohol and tobacco use, limited treatment knowledge, stigma, relocation, and forgetfulness. In contrast, adherence enhancing factors—nutritional support, adherence counseling, treatment supporters, and patient centered care—were associated with better treatment continuity.
Conclusion: TB treatment interruption remains a significant public health challenge in the EAC. Addressing socio economic vulnerabilities, strengthening health system capacity, and integrating patient centered adherence strategies are essential for improving treatment outcomes and advancing regional TB control efforts.

Key words: Tuberculosis; Treatment interruption; Treatment non-adherence; East African Community (EAC); Systematic review; Meta-analysis; HIV co-infection; Socio-economic determinants; Health system factors; Drug-resistant tuberculosis; Loss to follow-up; Treatment adherence.