{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T22:06:11Z","timestamp":1789596371597,"version":"build-2803163510"},"reference-count":47,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T00:00:00Z","timestamp":1740009600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the South African Medical Research Council Pilot"},{"name":"Walter Sisulu University"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Treatment outcomes are critical measures of TB treatment success, especially in resource-limited settings where tuberculosis remains a major public health issue. This study evaluated the treatment outcomes of patients with drug-resistant tuberculosis (DR-TB), co-infected with human immunodeficiency virus (HIV), and the impact of nutritional status, as measured by body mass index (BMI), on these outcomes in rural areas of the Olivier Reginald Tambo District Municipality, Eastern Cape, South Africa. Methods: A retrospective review of 360 patient files from four TB clinics and one referral hospital was conducted between January 2018 and December 2020. Data collected included patient demographics, clinical characteristics, BMI (categorized as underweight, normal, overweight, or obese), HIV status, DR-TB type, and treatment outcomes. Statistical analyses assessed the association between BMI categories, HIV status, and treatment outcomes. A scatter plot was used to illustrate BMI trends as a continuous variable in relation to age, enabling an analysis of BMI distribution across different age groups. Additionally, bar charts were utilized to explore categorical relationships and patterns in BMI across these groups. Results: The majority of patients were co-infected with HIV and had DR-TB, with rifampicin-resistant TB (RR-TB) and multidrug-resistant TB (MDR-TB) being the most prevalent forms. Treatment outcomes varied significantly by BMI category. Underweight patients had the lowest cure rates (23.2%), highlighting the adverse impact of malnutrition on DR-TB treatment success. Patients with normal BMI demonstrated higher cure rates (34.7%), while overweight and obese patients had moderate outcomes. HIV co-infection further reduced cure rates, with co-infected individuals showing poorer outcomes than HIV-negative patients. Gender disparities were also observed, with females achieving higher cure rates (39.1%) compared to males (31.4%). Weak trends linked BMI and DR-TB type, such as a higher prevalence of normal BMI among RR-TB cases. Conclusion: This study underscores the significant influence of nutritional status on DR-TB treatment outcomes, particularly among patients co-infected with HIV. Underweight patients face the greatest risk of poor outcomes, emphasizing the need for nutritional support as a critical component of DR-TB management. Comprehensive HIV care and gender-specific interventions are also essential to address disparities in treatment success. Tailored strategies focusing on these aspects can significantly enhance outcomes in high-burden, resource-limited settings.<\/jats:p>","DOI":"10.3390\/ijerph22030319","type":"journal-article","created":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T11:03:37Z","timestamp":1740049417000},"page":"319","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Outcomes of Treating Tuberculosis Patients with Drug-Resistant Tuberculosis, Human Immunodeficiency Virus, and Nutritional Status: The Combined Impact of Triple Challenges in Rural Eastern Cape"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0356-8912","authenticated-orcid":false,"given":"Ntandazo","family":"Dlatu","sequence":"first","affiliation":[{"name":"Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Private Bag X1, Mthatha 5117, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7308-4239","authenticated-orcid":false,"given":"Lindiwe M.","family":"Faye","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, Faculty of Health Sciences and National Health Laboratory Services (NHLS), Walter Sisulu University, Mthatha 5099, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1329-3864","authenticated-orcid":false,"given":"Teke","family":"Apalata","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, Faculty of Health Sciences and National Health Laboratory Services (NHLS), Walter Sisulu University, Mthatha 5099, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,20]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (WHO) (2022). Consolidated Guidelines on Tuberculosis, Module 4. Treatment\u2014Drug-Susceptible Tuberculosis Treatment, WHO."},{"key":"ref_2","unstructured":"World Health Organization (WHO) (2013). Definitions and Reporting Framework for Tuberculosis\u20142013 Revision: Updated December 2014 and January 2020, WHO."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Debash, H., Nega, J., Bisetegn, H., Tesfaw, G., Feleke, D.G., Ebrahim, H., Gedefie, A., Tilahun, M., Mohammed, O., and Alemayehu, E. (2023). Tuberculosis Treatment Outcomes and Its Predictors among Tuberculosis Patients Registered at Tefera Hailu Memorial General Hospital, Sekota Town, Northeast Ethiopia: A Seven-Year Retrospective Study. Can. J. Infect. Dis. Med. Microbiol., 2023.","DOI":"10.1155\/2023\/4212312"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/2049-9957-3-20","article-title":"Factors influencing adherence to the food by prescription program among adult HIV positive patients in Addis Ababa, Ethiopia: A facility-based, cross-sectional study","volume":"3","author":"Kebede","year":"2014","journal-title":"Infect. Dis. Poverty"},{"key":"ref_5","first-page":"235","article-title":"ASSAf Presidential Lecture 2003: \u2019Science\u2019 or \u2019Sciences\u2019: The difference one letter makes","volume":"100","author":"Gevers","year":"2005","journal-title":"S. Afr. J. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1080\/10408398.2012.679500","article-title":"Significance of nutrition in pulmonary tuberculosis","volume":"55","author":"Kant","year":"2015","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1093\/aje\/kws007","article-title":"Nutritional Risk Factors for Tuberculosis Among Adults in the United States, 1971\u20131992","volume":"176","author":"Arab","year":"2012","journal-title":"Am. J. Epidemiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1079\/PNS2006503","article-title":"Early immunological development and mortality from infectious disease in later life","volume":"65","author":"Moore","year":"2006","journal-title":"Proc. Nut. Soc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1080\/19390211.2018.1472165","article-title":"Malnutrition and associated disorders in tuberculosis and its therapy","volume":"16","author":"Martin","year":"2019","journal-title":"J. Diet. Suppl."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1007\/s11904-020-00483-5","article-title":"Obesity and Weight Gain in Persons with HIV","volume":"17","author":"Bailin","year":"2020","journal-title":"Curr. HIV\/AIDS Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1016\/S2213-2600(22)00092-3","article-title":"The intersecting pandemics of tuberculosis and COVID-19: Population-level and patient-level impact, clinical presentation, and corrective interventions","volume":"10","author":"Dheda","year":"2022","journal-title":"Lancet Respir. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"a5092","DOI":"10.4102\/safp.v62i1.5092","article-title":"An overview of the new rifampicin-resistant tuberculosis regimens available at decentralised drug-resistant tuberculosis sites for persons older than six years","volume":"62","author":"Muller","year":"2020","journal-title":"S. Afr. Fam. Pract."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Liebenberg, D., Gordhan, B.G., and Kana, B.D. (2022). Drug-resistant tuberculosis: Implications for transmission, diagnosis, and disease management. Front. Cell Infect. Microbiol., 12.","DOI":"10.3389\/fcimb.2022.943545"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/s42399-023-01568-z","article-title":"WHO Goals and Beyond: Managing HIV\/TB Co-infection in South Africa","volume":"5","author":"Olivier","year":"2023","journal-title":"SN Compr. Clin. Med."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Herbert, C., Luies, L., Loots, D.T., and Williams, A.A. (2023). The metabolic consequences of HIV\/TB co-infection. BMC Infect. Dis., 23.","DOI":"10.1186\/s12879-023-08505-4"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"a1594","DOI":"10.4102\/hsag.v26i0.1594","article-title":"A nutritional profile of patients with tuberculosis at Standerton Tuberculosis Specialised Hospital, Mpumalanga, South Africa","volume":"26","author":"Wessels","year":"2021","journal-title":"Health SA Gesondheid"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1097\/QAI.0000000000001071","article-title":"Weight Gain and Incident Diabetes Among HIV-Infected Veterans Initiating Antiretroviral Therapy Compared with Uninfected Individuals","volume":"73","author":"Herrin","year":"2016","journal-title":"J. Acquir. Immune Defic Syndr."},{"key":"ref_18","first-page":"20499361221095831","article-title":"Tuberculosis, and comorbidities: Treatment challenges in patients with comorbid diabetes mellitus and depression","volume":"9","author":"Calderon","year":"2022","journal-title":"Ther. Adv. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1097\/QAI.0b013e31827303d5","article-title":"Multimorbidity patterns in HIV-infected patients: The role of obesity in chronic disease clustering","volume":"61","author":"Kim","year":"2012","journal-title":"J. Acquir. Immune Defic. Syndr."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Jiang, J., Qin, X., Liu, H., Meng, S., Abdullah, A.S., Huang, J., Qin, C., Liu, Y., Huang, Y., and Qin, F. (2019). An optimal BMI range associated with a lower risk of mortality among HIV-infected adults initiating antiretroviral therapy in Guangxi, China. Sci. Rep., 9.","DOI":"10.1038\/s41598-019-44279-z"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Faye, L.M., Hosu, M.C., Iruedo, J., Vasaikar, S., Nokoyo, K.A., Tsuro, U., and Apalata, T. (2023). Treatment Outcomes and Associated Factors among Tuberculosis Patients from Selected Rural Eastern Cape Hospitals: An Ambidirectional Study. Trop. Med. Infect. Dis., 8.","DOI":"10.20944\/preprints202305.0493.v1"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1093\/cid\/cix852","article-title":"Association of Obesity, Diabetes, and Risk of Tuberculosis: Two Population-Based Cohorts","volume":"66","author":"Lin","year":"2018","journal-title":"Clin. Infect. Dis."},{"key":"ref_23","unstructured":"Field, A. (2013). Discovering Statistics with IBM SPSS, Sage."},{"key":"ref_24","unstructured":"Merriam-Webster (2016). Merriam-Webster Medical Dictionary, Merriam Webster."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2100804","DOI":"10.1183\/13993003.00804-2021","article-title":"World Health Organization treatment outcome definitions for tuberculosis: 2021 update","volume":"58","author":"Linh","year":"2021","journal-title":"Eur. Respir. J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"100311","DOI":"10.1016\/j.jctube.2022.100311","article-title":"Undernutrition is feeding the tuberculosis pandemic: A perspective","volume":"27","author":"Carwile","year":"2022","journal-title":"J. Clin. Tuberc. Other Mycobact. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Ko, Y., Kim, C., Park, Y.B., Mo, E.K., and Moon, J.W. (2020). Changes in Nutritional Status in Pulmonary Tuberculosis: Longitudinal Changes in BMI According to Acid-Fast Bacilli Smear Positivity. J. Clin. Med., 9.","DOI":"10.3390\/jcm9124082"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Limenh, L.W., Kasahun, A.E., Sendekie, A.K., Seid, A.M., Mitku, M.L., Fenta, E.T., Melese, M., Workye, M., Simegn, W., and Ayenew, W. (2024). Tuberculosis treatment outcomes and associated factors among tuberculosis patients treated at healthcare facilities of Motta Town, Northwest Ethiopia: A five-year retrospective study. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-58080-0"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Khan, F.U., Rehman, A.u., Khan, F.U., Hayat, K., Khan, A., Ahmad, N., Chang, J., Malik, U.R., and Fang, Y. (2022). Assessment of Factors Associated with Unfavorable Outcomes among Drug-Resistant TB Patients: A 6-Year Retrospective Study from Pakistan. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19031574"},{"key":"ref_30","first-page":"9952806","article-title":"Treatment outcomes and associated factors in tuberculosis patients at Atwima Nwabiagya district, Ashanti region, Ghana: A ten-year retrospective study","volume":"2021","author":"Agyare","year":"2021","journal-title":"Tuberc. Res. Treat."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e392","DOI":"10.1093\/cid\/ciaa054","article-title":"Impact of Diabetes and Low Body Mass Index on Tuberculosis Treatment Outcomes","volume":"71","author":"Kornfeld","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"100221","DOI":"10.1016\/j.jctube.2021.100221","article-title":"Treatment outcomes of drug-resistant tuberculosis patients with multiple poor prognostic indicators in Uganda: A countrywide 5-year retrospective study","volume":"23","author":"Baluku","year":"2021","journal-title":"J. Clin. Tuberc. Other Mycobact. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"6661","DOI":"10.2147\/IJGM.S367090","article-title":"Clinical Characteristics and Outcomes in Chronic Kidney Disease Patients with Tuberculosis in China: A Retrospective Cohort Study","volume":"15","author":"Xiao","year":"2022","journal-title":"Int. J. Gen. Med."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Oliveira, O., Gaio, R., Correia-Neves, M., Rito, T., and Duarte, R. (2021). Evaluation of drug-resistant tuberculosis treatment outcome in Portugal, 2000\u20132016. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0250028"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Sahile, Z., Tezera, R., Haile Mariam, D., Collins, J., and Ali, J.H. (2021). Nutritional status and TB treatment outcomes in Addis Ababa, Ethiopia: An ambi-directional cohort study. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0247945"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Musuenge, B.B., Poda, G.G., and Chen, P.C. (2020). Nutritional status of patients with tuberculosis and associated factors in the Burkina Faso health center region. Nutrients, 12.","DOI":"10.3390\/nu12092540"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1093\/cid\/ciac915","article-title":"Impact of Undernutrition on Tuberculosis Treatment Outcomes in India: A Multicenter, Prospective, Cohort Analysis","volume":"76","author":"Sinha","year":"2023","journal-title":"Clin. Infect. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"279","DOI":"10.11604\/pamj.2021.38.279.27270","article-title":"Malnutrition prevalence and associated biochemical factors among drug-resistance tuberculosis (DR-TB) patients at key treatment sites in Conakry City, Republic of Guinea","volume":"38","author":"Magassouba","year":"2021","journal-title":"Pan Afr. Med. J."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Cho, S.H., Lee, H., Kwon, H., Shin, D.W., Joh, H.K., Han, K., Park, J.H., and Cho, B. (2022). Association of underweight status with the risk of tuberculosis: A nationwide population-based cohort study. Sci. Rep., 12.","DOI":"10.1038\/s41598-022-20550-8"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"101505","DOI":"10.1016\/j.cegh.2024.101505","article-title":"Factors determining successful treatment outcome among notified tuberculosis patients in Belagavi district of North Karnataka, India","volume":"25","author":"Kumar","year":"2024","journal-title":"Clin. Epidemiol. Glob. Health"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Min, J., Kim, J.S., Kim, H.W., Ko, Y., Oh, J.Y., Jeong, Y.J., Lee, E.H., Yang, B., Lee, K.M., and Ahn, J.H. (2023). Effects of underweight and overweight on mortality in patients with pulmonary tuberculosis. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1236099"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1093\/pubmed\/fdaa146","article-title":"Factors influencing treatment outcomes of tuberculosis patients attending health facilities in Galkayo Puntland, Somalia","volume":"43","author":"Kassim","year":"2021","journal-title":"J. Public Health."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Simieneh, A., Gashaneh, S., and Dereje, R. (2024). Nutritional status and treatment outcomes of tuberculosis in Mizan Tepi University Teaching Hospital, a five-year retrospective study. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0298244"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s40249-024-01182-8","article-title":"A cross-sectional analysis of the effectiveness of a nutritional support programme for people with tuberculosis in Southern Madagascar using secondary data from a non-governmental organisation","volume":"13","author":"Franke","year":"2024","journal-title":"Infect. Dis. Poverty"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Song, W.M., Guo, J., Xu, T.T., Li, S.J., Liu, J.Y., Tao, N.N., Liu, Y., Zhang, Q.Y., Liu, S.Q., and An, Q.Q. (2021). Association between body mass index and newly diagnosed drug-resistant pulmonary tuberculosis in Shandong, China from 2004 to 2019. BMC Pulm. Med., 21.","DOI":"10.1186\/s12890-021-01774-2"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/s40249-018-0418-3","article-title":"A retrospective cohort study of body mass index and survival in HIV infected patients with and without TB co-infection","volume":"7","author":"Naidoo","year":"2018","journal-title":"Infect. Dis. Poverty"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1177\/0956462421992257","article-title":"HIV-associated tuberculosis","volume":"32","author":"Hamada","year":"2021","journal-title":"Int. J. 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