Determinants of tuberculosis presentation and successful treatment outcome among tuberculosis patients in Geita, Tanzania.

The Geita Region of Tanzania is known as critical focal point for tuberculosis (TB) control due to its persistently high disease burden and unique socio-economic landscape. Despite this, limited research has explored how sociodemographic and clinical factors influence TB presentation (pulmonary versus extrapulmonary) and successful treatment outcome. This study aimed to identify these factors within this community to inform targeted interventions. We conducted a retrospective cohort study of TB cases aged 15 years and above, who were notified in Geita Region from January 2017 to December 2020. Data were obtained from the national TB program registers, and included sociodemographic, clinical, and treatment information. The primary outcomes were TB presentation (Pulmonary vs. Extrapulmonary) and treatment outcome, categorized as successful (a composite of "cured" and "treatment completed") or unsuccessful (death, failure, and loss to follow-up). Multivariable binary logistic regression was applied to assess associations with TB presentation and treatment outcomes, including potential interaction effects between factors. Statistical analyses were performed using SAS OnDemand for initial data cleaning, and Stata 17.0 for all statistical modeling. A total of 13,107 TB cases were included, of which 12,032 (91.9%) pulmonary TB and 1,058 (8.1%) extrapulmonary TB. Logistic regression showed workplace significantly associated with presentation: prisoners had lower odds of pulmonary TB compared to miners (OR 0.26, 95% CI 0.12-0.58). Community-referred cases had higher odds of pulmonary TB than self-referred cases (OR 1.24, 95% CI 1.06-1.45). New TB cases had lower odds of pulmonary TB compared with relapse (OR 0.33, 95% CI 0.15-0.75). Age × sex and HIV × sex interactions associated with differential presentation risks. Treatment success was achieved in 12,385 patients (95.5%), while 581 (4.5%) experienced unsuccessful outcomes. Predictors of successful treatment included age < 60 years (OR 1.31, 95% CI 1.05-1.65), new TB status (OR 2.45, 95% CI 1.53-3.93), and HIV-negative status (OR 1.90, 95% CI 1.53-2.37). Workplace, referral source, and HIV status significantly influence TB presentation and treatment outcomes. Implementation targeted interventions, including strengthened occupational health policies, enhanced community-based screening, and focused strategies for high-risk groups is essential to improving TB control in Tanzania.