{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T21:21:59Z","timestamp":1791580919892,"version":"4.3.4"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV- 007130"],"award-info":[{"award-number":["INV- 007130"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV- 007130"],"award-info":[{"award-number":["INV- 007130"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"name":"South African National Research Foundation SARChI Chair in Paediatric Tuberculosis"},{"name":"DS-I Africa Fogarty award","award":["U01TW012626"],"award-info":[{"award-number":["U01TW012626"]}]},{"DOI":"10.13039\/501100000761","name":"Imperial College London","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000761","id-type":"DOI","asserted-by":"publisher"}]},{"name":"South African Research Chairs Initiative"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tuberculosis (TB) incidence peaks in women during their reproductive years and is a leading cause of maternal mortality. Pregnant women with TB have a high risk of failure to initiate TB treatment and poor TB treatment and pregnancy outcomes. We determined the time to treatment initiation in pregnant women diagnosed with TB in a routine programmatic setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using routine linked electronic data, we identified women 15\u201345 years of age with laboratory-confirmed and\/or clinically diagnosed TB, October 2018-December 2020, in two high-burden sub-districts in Cape Town, South Africa. We compared demographic and clinical characteristics in women with TB by pregnancy status, used time-to-event analysis to determine the time from TB diagnosis to initiation of antituberculosis treatment and Cox regression to assess determinants of treatment initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 5,459 women diagnosed with TB, 292 (5.3%) were pregnant. The median age for pregnant women was 28.6 years (interquartile range [IQR]: 23.7\u201333.7) and non-pregnant women 31 years (IQR:25.2\u201336.5). HIV prevalence was similar in pregnant (177\/292; 60.6%) vs non-pregnant (3200\/5167; 61.9%) women. Median time to treatment initiation was two days for pregnant and non-pregnant women. Most (92% of non-pregnant and 89% of pregnant) women initiated treatment within the first month after their TB diagnosis, after which the rate plateaued in both groups. Time to treatment initiation over 6 months was statistically different (Kaplan Meier Log-rank test, p\u2009=\u20090.0064) with pregnant women lagging behind non-pregnant women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>More than 5% of women diagnosed with TB were pregnant at the time of TB diagnosis. While pregnant women with TB were appropriately initiated on treatment, almost 15% were never started on treatment and there were delays in treatment initiation. While strategic interventions to prioritise early treatment initiation are needed, there should be a specific focus on pregnant women who have not initiated treatment within one month after TB diagnosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0344059","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T17:28:56Z","timestamp":1785778136000},"page":"e0344059","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Time to treatment initiation in pregnant women with tuberculosis in Cape Town, South Africa"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0826-1833","authenticated-orcid":true,"given":"Sue-Ann","family":"Meehan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anneke C.","family":"Hesseling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Kalk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer A.","family":"Hughes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James A.","family":"Seddon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria E.","family":"Namukuta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Osman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"pone.0344059.ref001","volume-title":"Global Tuberculosis Report 2025","author":"World Health Organization","year":"2025"},{"issue":"2","key":"pone.0344059.ref002","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1097\/QAI.0b013e3181900201","article-title":"Intensified case finding for tuberculosis in prevention of mother-to-child transmission programs: a simple and potentially vital addition for maternal and child health","volume":"50","author":"A Deluca","year":"2009","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"11","key":"pone.0344059.ref003","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.1093\/cid\/cis732","article-title":"Tuberculosis in pregnant and postpartum women: epidemiology, management, and research gaps","volume":"55","author":"JS Mathad","year":"2012","journal-title":"Clin Infect Dis"},{"issue":"1","key":"pone.0344059.ref004","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1186\/s12889-018-5362-4","article-title":"TB epidemiology: where are the young women? Know your tuberculosis epidemic, know your response","volume":"18","author":"R Perumal","year":"2018","journal-title":"BMC Public Health"},{"key":"pone.0344059.ref005","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1186\/1756-0500-7-629","article-title":"Causes of death among females-investigating beyond maternal causes: a community-based longitudinal study","volume":"7","author":"YA Melaku","year":"2014","journal-title":"BMC Res Notes"},{"issue":"3","key":"pone.0344059.ref006","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(25)00431-0","article-title":"Global estimates of tuberculosis incidence during pregnancy and postpartum: a rapid review and modelling analysis","volume":"14","author":"N Mafirakureva","year":"2026","journal-title":"Lancet Glob Health"},{"key":"pone.0344059.ref007","article-title":"The Impact of Pregnancy on Tuberculosis Treatment Outcomes: An Analysis of Brazilian National Surveillance Data 2016-2022","author":"SS Chiang","year":"2025","journal-title":"Clin Infect Dis"},{"issue":"7","key":"pone.0344059.ref008","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1093\/cid\/ciaa189","article-title":"Maternal and Infant Outcomes Among Pregnant Women Treated for Multidrug\/Rifampicin-Resistant Tuberculosis in South Africa","volume":"72","author":"M Loveday","year":"2021","journal-title":"Clin Infect Dis"},{"issue":"1","key":"pone.0344059.ref009","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1186\/s12884-021-03956-6","article-title":"Treatment and pregnancy outcomes of pregnant women exposed to second-line anti-tuberculosis drugs in South Africa","volume":"21","author":"I Mokhele","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"key":"pone.0344059.ref010","first-page":"27","article-title":"Tuberculosis in pregnant women and neonates: A meta-review of current evidence","volume":"36","author":"S K J","year":"2020","journal-title":"Paediatr Respir Rev"},{"issue":"5","key":"pone.0344059.ref011","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1111\/1471-0528.14408","article-title":"Maternal and perinatal mortality and morbidity associated with tuberculosis during pregnancy and the postpartum period: a systematic review and meta-analysis","volume":"124","author":"S Sobhy","year":"2017","journal-title":"BJOG"},{"issue":"2","key":"pone.0344059.ref012","article-title":"Association between tuberculosis and pregnancy outcomes: a retrospective cohort study of women in Cape Town, South Africa","volume":"14","author":"S-A Meehan","year":"2024","journal-title":"BMJ Open"},{"key":"pone.0344059.ref013","volume-title":"WHO Operational Handbook on Tuberculosis. 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