ArticleBMC infectious diseases2026
Shifts in tuberculosis treatment outcomes despite timely treatment initiation during and after the COVID-19 pandemic: a retrospective cohort study in a tertiary-level hospital in Mexico.
Article in BMC infectious diseases, 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
backgroundThe COVID-19 pandemic disrupted tuberculosis (TB) services worldwide, primarily affecting diagnosis and treatment initiation. However, the impact of the post-pandemic period on TB treatment outcomes remains poorly understood. We aimed to evaluate changes in TB treatment outcomes during and after the COVID-19 pandemic and to determine whether these changes occurred independently of delays in treatment initiation.
methodsWe conducted a retrospective cohort study including adult patients diagnosed with TB at a tertiary referral hospital in Mexico between 2020 and 2025. Patients were categorized into COVID (2020-2022) and post-COVID (2023-2025) periods. The primary outcome was unfavorable treatment outcome (death, loss to follow-up, or treatment failure). Time from diagnosis to treatment initiation was assessed, and clinically relevant delay was defined using multiple thresholds. Multivariable logistic regression and Cox proportional hazards models were used to evaluate associations between period and outcomes, adjusting for age, sex, HIV status, undernutrition, and TB characteristics. Sensitivity analyses included exclusion of patients with HIV and socially vulnerable populations.
resultsA total of 1,299 patients were included. The proportion of unfavorable outcomes increased from 27.1% in the COVID period to 34.4% in the post-COVID period (p < 0.001), driven by a marked increase in TB-related mortality (2.1% vs. 10.6%). Time to treatment initiation did not differ between periods (median 0 days in both groups). In multivariable analysis, the post-COVID period was independently associated with unfavorable outcomes (adjusted OR 1.39, 95% CI 1.03-1.88) and higher hazard of adverse events (HR 1.33, 95% CI 1.09-1.63). Sensitivity analyses showed attenuation of this association after excluding patients with HIV (aOR 1.21, 95% CI 0.89-1.65), though the direction of effect remained consistent. The post-COVID cohort exhibited higher prevalence of diabetes and substance use, alongside shifts in sociodemographic characteristics.
conclusionTuberculosis treatment outcomes worsened in the post-COVID period despite largely preserved overall timeliness of treatment initiation. These findings suggest that factors beyond treatment initiation delay, including clinical complexity, comorbidity burden, and potential challenges in continuity of care, may have contributed to adverse outcomes.
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