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We sought to identify factors associated with a decreased risk of unfavourable TB treatment outcomes among people living with HIV\u2010infection (PLHIV) in low\u2010 and middle\u2010income countries (LMIC), with a specific focus on directly observed therapy (DOT) compared with self\u2010administered therapy (SAT) during the continuation phase of anti\u2010TB therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective cohort study among adults diagnosed with HIV\u2010associated TB in Africa, Asia and the Americas from 2012 to 2013; data were collected from 2012 to 2016. Unfavourable TB treatment outcomes (death during TB treatment, and TB treatment failure or recurrence) were defined according to World Health Organization criteria. Receipt of DOT was obtained at the site level and defined as \u22655\u00a0days of DOT per week. The person administering DOT and treatment location varied by site. Lack of receipt of DOT was defined as SAT. Multivariable logistic regression estimated the adjusted odds of unfavourable TB treatment outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 1862 adults with HIV\u2010associated TB included, 252 (13.5%) had unfavourable TB outcomes (226 deaths, 26 recurrences\/failures). Overall, 1825 (98%) received DOT in the intensive phase and 1617 (87%) received DOT in the continuation phase. DOT in the continuation phase was not significantly associated with unfavourable TB outcomes (aOR 1.43, 95% CI 0.86 to 2.38) compared to SAT. Body mass index (BMI) change during anti\u2010TB treatment (per 2 units increase, aOR 0.74, 95% CI 0.68 to 0.82) and CD4<jats:sup>+<\/jats:sup> count at TB diagnosis (200 vs. 50 \u00a0cells\/\u00b5L, aOR 0.54, 95% CI 0.39 to 0.73) were both independently associated with decreased odds of unfavourable TB treatment outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In this large, international cohort of people living with HIV\u2010associated TB in LMIC who received intensive phase DOT, DOT during the continuation phase of anti\u2010TB therapy was not associated with a decreased odds of unfavourable TB treatment outcomes compared to SAT. Randomized trials evaluating the effect of continuation\u2010phase DOT on TB outcomes among PLHIV are needed.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25423","type":"journal-article","created":{"date-parts":[[2019,12,9]],"date-time":"2019-12-09T07:10:27Z","timestamp":1575875427000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Directly observed therapy and risk of unfavourable tuberculosis treatment outcomes among an international cohort of people living with HIV in low\u2010 and middle\u2010income countries"],"prefix":"10.1002","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8832-0866","authenticated-orcid":false,"given":"April C","family":"Pettit","sequence":"first","affiliation":[{"name":"Department of Medicine Vanderbilt University Medical Center Nashville TN USA"},{"name":"Vanderbilt Tuberculosis Center Nashville TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cathy A","family":"Jenkins","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Vanderbilt University Medical Center Nashville TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meridith","family":"Blevins Peratikos","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Vanderbilt University Medical Center Nashville TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2110-2631","authenticated-orcid":false,"given":"Marcel","family":"Yotebieng","sequence":"additional","affiliation":[{"name":"College of Public Health The Ohio State University Columbus OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lameck","family":"Diero","sequence":"additional","affiliation":[{"name":"Academic Model Providing Access To Healthcare (AMPATH) Eldoret Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cuong D","family":"Do","sequence":"additional","affiliation":[{"name":"Bach Mai Hospital Hanoi Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Ross","sequence":"additional","affiliation":[{"name":"TREAT Asia\/amfAR \u2013 The Foundation for AIDS Research Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valdilea G","family":"Veloso","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Infectologia Evandro Chagas Funda\u00e7\u00e3o Oswaldo Cruz Rio de Janeiro RJ Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise","family":"Hawerlander","sequence":"additional","affiliation":[{"name":"Centre Int\u00e9gr\u00e9 de Recherches Biocliniques d'Abidjan CIRBA Abidjan C\u00f4te d'Ivoire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Marcy","sequence":"additional","affiliation":[{"name":"Centre INSERM U1219 Bordeaux Population Health University of Bordeaux Bordeaux France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan E","family":"Shepherd","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Vanderbilt University Medical Center Nashville TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Fenner","sequence":"additional","affiliation":[{"name":"Institute of Social and Preventive Medicine University of Bern Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy R","family":"Sterling","sequence":"additional","affiliation":[{"name":"Department of Medicine Vanderbilt University Medical Center Nashville TN USA"},{"name":"Vanderbilt Tuberculosis Center Nashville TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the International Epidemiology Databases to Evaluate AIDS (IeDEA) Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,12,8]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"Global Tuberculosis Report 2018","author":"World Health Organization"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.15.0731"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-016-3362-9"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.15-0668"},{"issue":"2","key":"e_1_2_9_6_1","first-page":"105","article-title":"Factors associated with drug resistance in pulmonary tuberculosis","volume":"45","author":"Johnson J","year":"2003","journal-title":"Indian J Chest Dis Allied Sci"},{"key":"e_1_2_9_7_1","volume-title":"Treatment of Tuberculosis Guidelines\u2010Fourth Edition 2009","author":"World Health Organization"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-018-0224-2"},{"key":"e_1_2_9_9_1","unstructured":"Organization WH.End TB Strategy 2013[cited 2019 Oct 8]. 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