Abstract
Tuberculosis (TB) continues to be a significant public health concern in Johannesburg, South Africa, influenced by a complex interplay of individual, social, and structural determinants. This study assessed the syndemic relationship between these factors to understand their impact on TB prevalence and treatment outcomes. Data was collected from TB patients at selected clinics, analysing behavioural risks (smoking, alcohol use, HIV co-infection), social conditions (poverty, overcrowding, stigma), and structural barriers (healthcare access, migration status). Guided by the Host-Agent-Environment framework and Syndemic Theory, a quantitative cross-sectional design was used. A multistage cluster sampling method was employed. The data were analysed using SPSS version 29.0, with techniques such as principal component analysis applied to test syndemic relationships.
Findings reveal a strong association between TB and HIV (56.1%), as well as high rates of smoking (33.1%) and alcohol use (45.2%). Social determinants such as unemployment (50.2%) and poor housing conditions contribute significantly to TB transmission. Structural challenges, including limited healthcare access for undocumented migrants (26.2%), further exacerbate treatment delays. Factor analysis confirms a syndemic relationship between individual behavioural risk factors such as smoking, alcohol use, and substance abuse and social determinants, including poverty, unemployment, and overcrowding, highlighting the need for a multi-sectoral approach to TB control.
The study recommends that addressing TB requires integrating medical treatment with social interventions, including TB-HIV co-management, substance abuse reduction programmes, improved housing, and expanded healthcare accessibility. A holistic strategy targeting both health and socioeconomic disparities is also essential for effective TB prevention and management in Johannesburg.