Mortality hazards after treatment completion of pulmonary tuberculosis in a tertiary hospital in Uganda.

Objectives: Treated pulmonary tuberculosis (PTB) is associated with long-term complications that contribute to substantial morbidity and mortality. We estimated the incidence and predictors of post-PTB mortality and evaluated whether chronic pulmonary aspergillosis (CPA) independently increases the risk of death. Methods: Between July 1, 2020 and June 30, 2021, we enrolled 162 individuals with treated drug-susceptible PTB who had persistent respiratory symptoms and screened them for CPA using a symptom checklist, chest x-ray, Results: Thirty-seven (22.8%) participants were lost to follow-up. The median follow-up duration was 3.8 years (interquartile range 3.6-3.9). Of the 125 participants with vital status, their mean age was 33.5 years (±11.7). At baseline, 46 (36.8%) had far advanced PTB, 64 (51.2%) had pulmonary fibrosis, 15 (12.0%) had a history of previous TB, and 34 (27.2%) were living with HIV. Coinfection with PTB and CPA was identified in 31 participants at baseline (24.8%). The median St. George's respiratory questionnaire score was 50.9 (interquartile range 40.9-63.3), and 32.0% (n = 40) had scores above 60, indicating poor health-related quality of life. Overall mortality was 8.8% (95% confidence interval [CI] 4.4-15.2%), with a mortality rate of 24.3 deaths per 1000 person-years of follow-up. Mortality rates were comparable among participants with and without CPA-PTB coinfection. Independent predictors of mortality included a St. George's respiratory questionnaire score >60 (adjusted hazard ratio = 2.01; 95% CI 1.49-2.72; Conclusions: Post-PTB mortality remains high, with poor health-related quality of life and HIV co-infection emerging as significant independent predictors of death. Integrating long-term follow-up, respiratory rehabilitation, and fungal diagnostics into post-TB care pathways is essential to improve outcomes and reduce preventable mortality.