{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T03:16:21Z","timestamp":1783480581233,"version":"3.55.0"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R21AI148852"],"award-info":[{"award-number":["R21AI148852"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R21AI163977"],"award-info":[{"award-number":["R21AI163977"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01AI150485"],"award-info":[{"award-number":["R01AI150485"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32AI114398"],"award-info":[{"award-number":["T32AI114398"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Timeously completing tuberculosis (TB) treatment is a key to optimal health outcomes. Suboptimal treatment refill patterns, even among those categorized as \u201ctreatment success,\u201d may portend unfavorable outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using patient-level medication refill data, latent-class mixed modeling was used to identify longitudinal trajectories of care engagement among TB patients achieving programmatic treatment success. Logistic regression was conducted to investigate participant-level characteristics associated with trajectory class membership.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 548 participants, we identified 3 trajectories: Class 1 (consistent engagement; 84.1%), Class 2 (suboptimal engagement after 2 months; 7.7%), and Class 3 (suboptimal engagement from initiation; 8.2%). At treatment completion, Classes 1\u20133 accumulated 9.7 (95% confidence interval [CI]: 7.4\u201311.8), 68.4 (60.4\u201376.9), and 55.5 (48.1\u201362.7) missed refill days, respectively. In gender-stratified models, men exhibited all 3 trajectories (83.1%, 7.4%, and 9.5%, respectively), and accumulated 10.6 (7.8\u201313.3), 61.0 (50.2\u201371.3), and 62.31 (53.14\u201371.72) missed refill days, respectively. Women exhibited only Classes 1 and 3 (89.5% and 10.5%, respectively) and accumulated 12.1 (7.8\u201316.5) and 46.9 (33.3\u201361.6) missed refill days, respectively. Among men, prior TB (Class 2: adjusted odds ratio [aOR] 7.44, 2.79\u201319.8; Class 3: aOR 2.78, 1.07\u20137.25) and human immunodeficiency virus\u2013negative status (Class 3: aOR 2.72, 1.13\u20136.54) were associated with suboptimal trajectories. Among women, prior TB was associated with suboptimal engagement (aOR 5.22, 1.11\u201324.44).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Programmatic \u201ctreatment success\u201d obscured heterogeneity in treatment refill patterns. Patient-centered counseling and gender-responsive interventions are needed to address treatment refill behaviors. Shorter regimens alone may not resolve suboptimal engagement, highlighting the need for flexible treatment strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciaf714","type":"journal-article","created":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T12:58:55Z","timestamp":1766062735000},"page":"e1292-e1301","source":"Crossref","is-referenced-by-count":1,"title":["Hidden in Success: Gendered Patterns of Suboptimal Care Engagement Among Tuberculosis Patients Who \u201cSuccessfully\u201d Completed Treatment in South Africa"],"prefix":"10.1093","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0095-4141","authenticated-orcid":false,"given":"Andrew","family":"Medina-Marino","sequence":"first","affiliation":[{"name":"Desmond Tutu HIV Centre, University of Cape Town , Cape Town ,","place":["South Africa"]},{"name":"Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0401-8004","authenticated-orcid":false,"given":"Eke","family":"Arua","sequence":"additional","affiliation":[{"name":"School of Public Health, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5804-7651","authenticated-orcid":false,"given":"Lindsey","family":"de Vos","sequence":"additional","affiliation":[{"name":"Desmond Tutu HIV Centre, University of Cape Town , Cape Town ,","place":["South Africa"]},{"name":"School of Public Health, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuhle","family":"Fiphaza","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania ,","place":["USA"]},{"name":"Foundation for Professional Development , East London ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Bezuidenhout","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Mailman School of Public Health, Columbia University , New York, New York ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nondumiso","family":"Ngcelwane","sequence":"additional","affiliation":[{"name":"Department of Health, Buffalo City Metro Health District , Eastern Cape Province ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7143-1009","authenticated-orcid":false,"given":"Salome","family":"Charalambous","sequence":"additional","affiliation":[{"name":"The Aurum Institute , Johannesburg ,","place":["South Africa"]},{"name":"Faculty of Health Sciences, School of Public Health, University of the Witwatersrand , Johannesburg ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4607-9568","authenticated-orcid":false,"given":"Joseph","family":"Daniels","sequence":"additional","affiliation":[{"name":"Edson College of Nursing and Health Innovation, Arizona State University , Phoenix, Arizona ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,12,19]]},"reference":[{"key":"2026070722325403100_ciaf714-B1","volume-title":"WHO consolidated guidelines on tuberculosis. 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