ArticlemedRxiv : the preprint server for health sciences2026
Evaluating tuberculosis treatment outcomes and predictors in five Southern African countries: A multi-country cohort analysis.
Article in medRxiv : the preprint server for health sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Despite global progress in tuberculosis (TB) control, treatment outcomes remain suboptimal, particularly in high-burden settings and among people with HIV or drug-resistant TB. Identifying predictors of unsuccessful treatment is essential to improve TB care and policy. Methods: We evaluated TB treatment outcomes and patient characteristics associated with unsuccessful outcomes in five cohorts of the International epidemiology database to evaluate AIDS (IeDEA); Center for Infectious Disease Research, Zambia; Chiure health center, Mozambique; Martin Preuss Center, Lighthouse clinic, Malawi; Masvingo health center Zimbabwe; and Themba Lethu clinic, Hellen Joseph hospital, South Africa. We included all patients with TB aged ≥ 15 years starting TB treatment and assessed their treatment outcomes in association with sociodemographic and clinical characteristics using multivariable mixed-effects models. Unsuccessful outcomes were defined as death, loss to follow-up and treatment failure. Results: Among 1438 people with TB, median age was 39 years, 67% males, 40% with HIV, and 4% with MDR-TB; 1151 (80%) treatment outcomes were successful (606 cured and 545 completed treatment), 221 (15%) unsuccessful (89 deaths, 129 loss to follow-up and 3 treatment failures), and 66 (5%) other (49 unknown and 17 transfer-outs). Unsuccessful outcomes were more probable among people with multidrug-resistant TB (MDR-TB) and among participants without formal education. Risk of death was lower for people with bacteriologically confirmed TB (adjusted odds ratio (aOR) 0.5, 95%-credible interval [CI] 0.25-0.80), those with a secondary or higher education (aOR 0.3, 95%-CI 0.13-0.69) and BMI ≥18 kg/m Conclusions: TB treatment outcomes fell short of the targets set by the World Health Organization of <10% unsuccessful outcomes, indicating a critical need for enhanced management strategies. Tackling loss to follow-up is crucial, especially among MDR-TB patients, including stronger retention activities and improved diagnostic capacities.
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