{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:46:18Z","timestamp":1787028378228,"version":"build-2736575974"},"reference-count":39,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Walter Sisulu University, Faculty of Medicine and Health Sciences, School of Health"},{"id":[{"id":"https:\/\/ror.org\/02svzjn28","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Department of Public Health"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Drug-resistant tuberculosis (DR-TB) remains a major public health challenge in South Africa, particularly in rural settings with high HIV co-infection rates. Understanding predictors of treatment response among people living with HIV is essential for improving clinical management and programmatic outcomes. This study aimed to identify socio-demographic and clinical predictors of treatment outcomes among HIV-positive individuals diagnosed with multidrug-resistant (MDR) and extensively drug-resistant tuberculosis (XDR-TB) in rural Eastern Cape Province, South Africa. Methods: A retrospective cohort study was conducted using routinely collected clinical records of DR-TB patients initiated on treatment between January 2020 and December 2024 at two public healthcare facilities. A total of 239 patients with complete treatment outcome data were included. Treatment outcomes were classified as favourable (cured or treatment completed) or unfavourable (death, treatment failure, or loss to follow-up). Descriptive statistics were used to summarise patient characteristics, while univariate and multivariable logistic regression analyses were performed to identify factors associated with treatment outcomes. Results: Most participants were aged \u2264 39 years (58%), male (60%), unemployed (90%), and without income (80%). MDR-TB accounted for 40% of cases, rifampicin-resistant-TB (RR-TB) for 53%, and XDR-TB for 7.1%. Multivariable analysis showed that XDR-TB was the strongest independent predictor of unfavourable treatment outcome (AOR = 0.18; 95% CI: 0.06\u20130.58; p = 0.004). Income status was also significantly associated with outcome, with participants reporting some incomes having lower odds of favourable outcomes (AOR = 0.46; 95% CI: 0.23\u20130.92; p = 0.036). The model demonstrated modest predictive performance (AUC = 0.67). Conclusions: These findings highlight the dominant influence of resistance phenotype, particularly XDR-TB, on treatment prognosis among HIV-positive DR-TB patients in rural Eastern Cape. Integrating early resistance profiling, intensified clinical management of XDR-TB, and socioeconomic support mechanisms may improve treatment outcomes in high-burden rural settings.<\/jats:p>","DOI":"10.3390\/ijerph23040474","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T12:21:32Z","timestamp":1775737292000},"page":"474","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Predictors of Treatment Outcomes Among HIV-Positive Patients with Drug-Resistant Tuberculosis in Rural Eastern Cape, South Africa: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"23","author":[{"given":"Thembile","family":"Zini","sequence":"first","affiliation":[{"name":"School of Public Health, Faculty of Medicine and Health Sciences, Walter Sisulu University, Private Bag X1, Mthatha 5100, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7991-0610","authenticated-orcid":false,"given":"Urgent","family":"Tsuro","sequence":"additional","affiliation":[{"name":"WSU TB Research Group, School of Pathology, Faculty of Medicine and Health Sciences, Walter Sisulu University, Private Bag X1, Mthatha 5100, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7308-4239","authenticated-orcid":false,"given":"Lindiwe Modest","family":"Faye","sequence":"additional","affiliation":[{"name":"WSU TB Research Group, School of Pathology, Faculty of Medicine and Health Sciences, Walter Sisulu University, Private Bag X1, Mthatha 5100, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ncomeka","family":"Sineke","sequence":"additional","affiliation":[{"name":"WSU TB Research Group, School of Pathology, Faculty of Medicine and Health Sciences, Walter Sisulu University, Private Bag X1, Mthatha 5100, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6292-1956","authenticated-orcid":false,"given":"Monwabisi","family":"Faleni","sequence":"additional","affiliation":[{"name":"School of Public Health, Faculty of Medicine and Health Sciences, Walter Sisulu University, Private Bag X1, Mthatha 5100, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S20","DOI":"10.1016\/j.ijid.2022.03.026","article-title":"Drug resistant TB\u2013latest developments in epidemiology, diagnostics and management","volume":"124","author":"Tiberi","year":"2022","journal-title":"Int. J. Infect. Dis."},{"key":"ref_2","first-page":"e35154","article-title":"Multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) among children: Where we stand now","volume":"15","author":"Chowdhury","year":"2023","journal-title":"Cureus"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Dlatu, N., Faye, L.M., and Apalata, T. (2025). 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. Int. J. Environ. Res. Public Health, 22.","DOI":"10.3390\/ijerph22030319"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Hosu, M.C., Faye, L.M., and Apalata, T. (2024). Comorbidities and treatment outcomes in patients diagnosed with drug-resistant tuberculosis in rural Eastern Cape Province, South Africa. Diseases, 12.","DOI":"10.3390\/diseases12110296"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"9","DOI":"10.2147\/HIV.S193059","article-title":"Drug-resistant tuberculosis and HIV infection: Current perspectives","volume":"13","author":"Singh","year":"2020","journal-title":"HIV\/AIDS-Res. Palliat. Care"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Teferi, M.Y., El-Khatib, Z., Boltena, M.T., Andualem, A.T., Asamoah, B.O., Biru, M., and Adane, H.T. (2021). Tuberculosis treatment outcome and predictors in Africa: A systematic review and meta-analysis. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph182010678"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"4953","DOI":"10.4102\/PHCFM.v17i1.4953","article-title":"Predictors of drug-resistant TB outcomes: Body mass index, HIV, and comorbidities","volume":"17","author":"Dlatu","year":"2025","journal-title":"Afr. J. Prim. Health Care Fam. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1186\/s12981-023-00572-6","article-title":"Current ART, determinants for virologic failure and implications for HIV drug resistance: An umbrella review","volume":"20","author":"SeyedAlinaghi","year":"2023","journal-title":"AIDS Res. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"26","DOI":"10.2174\/1871526523666230725103902","article-title":"An overview of the global alarming increase of multiple drug resistant: A major challenge in clinical diagnosis","volume":"24","author":"Alara","year":"2024","journal-title":"Infect. Disord. Drug Targets"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"547","DOI":"10.2174\/1568026621999201211200447","article-title":"Tuberculosis: An update on pathophysiology, molecular mechanisms of drug resistance, newer anti-TB drugs, treatment regimens and host-directed therapies","volume":"21","author":"Borah","year":"2021","journal-title":"Curr. Top. Med. Chem."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1021\/acsinfecdis.5c00001","article-title":"Recent advances in immunotherapeutic and vaccine-based approaches for the treatment of drug-resistant bacterial infections","volume":"11","author":"Odoom","year":"2025","journal-title":"ACS Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Faye, L.M., Hosu, M.C., Dlatu, N., Iruedo, J., and Apalata, T. (2025). Predicting treatment adherence in patients with drug-resistant tuberculosis: Insights from socioeconomic, demographic, and clinical factors of patients in the rural Eastern Cape. Front. Tuberc., 3.","DOI":"10.3389\/ftubr.2025.1659333"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Kimani, E., Muhula, S., Kiptai, T., Orwa, J., Odero, T., and Gachuno, O. (2021). Factors influencing TB treatment interruption and treatment outcomes among patients in Kiambu County, 2016\u20132019. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0248820"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Reddy, S.C., Mohan, K.G., and Jain, K. (2025). Impact of socioeconomic factors on the treatment of tuberculosis. Emerging Paradigms in Delivery Systems for Antitubercular Therapy, Academic Press.","DOI":"10.1016\/B978-0-443-24035-5.00016-5"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Gilmour, B., and Alene, K.A. (2024). Ending tuberculosis: Challenges and opportunities. Front. Tuberc., 2.","DOI":"10.3389\/ftubr.2024.1487518"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e00180-19","DOI":"10.1128\/cmr.00180-19","article-title":"The changing paradigm of drug-resistant tuberculosis treatment: Successes, pitfalls, and future perspectives","volume":"35","author":"Dookie","year":"2022","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Soedarsono, S., Mertaniasih, N.M., Kusmiati, T., Permatasari, A., Ilahi, W.K., and Anggraeni, A.T. (2023). Characteristics of previous tuberculosis treatment history in patients with treatment failure and the impact on acquired drug-resistant tuberculosis. Antibiotics, 12.","DOI":"10.3390\/antibiotics12030598"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Shah, H.D., Nazli Khatib, M., Syed, Z.Q., Gaidhane, A.M., Yasobant, S., Narkhede, K., Bhavsar, P., Patel, J., Sinha, A., and Puwar, T. (2022). Gaps and interventions across the diagnostic care cascade of TB patients at the level of patient, community and health system: A qualitative review of the literature. Trop. Med. Infect. Dis., 7.","DOI":"10.3390\/tropicalmed7070136"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Al-Worafi, Y.M. (2023). Tuberculosis management in developing countries. Handbook of Medical and Health Sciences in Developing Countries: Education, Practice, and Research, Springer International Publishing.","DOI":"10.1007\/978-3-030-74786-2_52-1"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"128","DOI":"10.11604\/pamj.2021.39.128.27726","article-title":"Predictors of mortality and treatment success of multi-drug resistant and Rifampicin resistant tuberculosis in Zimbabwe: A retrospective cohort analysis of patients initiated on treatment during 2010 to 2015","volume":"39","author":"Matambo","year":"2021","journal-title":"Pan Afr. Med. J."},{"key":"ref_21","unstructured":"Nangombe, V.N.T. (2022). Predictors of Treatment Success Among Patients with Drug Resistant Tuberculosis in Namibia. [Doctoral Dissertation, University of Namibia]."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"38","DOI":"10.4103\/ijmy.ijmy_244_21","article-title":"Predictors of treatment outcomes in drug resistant tuberculosis-observational retrospective study","volume":"11","author":"Johnson","year":"2022","journal-title":"Int. J. Mycobacteriol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"6004","DOI":"10.4102\/SAFP.v66i1.6004","article-title":"Factors associated with unfavourable treatment outcomes among tuberculosis patients at health facilities of Maseru, Lesotho","volume":"66","author":"Leketa","year":"2024","journal-title":"S. Afr. Fam. Pract."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Nxumalo, E.L., Sineke, N., Dlatu, N., Apalata, T., and Faye, L.M. (2025). Treatment Outcomes of Tuberculosis in the Eastern Cape: Clinical and Socio-Demographic Predictors from Two Rural Clinics. Int. J. Environ. Res. Public Health, 22.","DOI":"10.3390\/ijerph22121804"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Hosu, M.C., Faye, L.M., and Apalata, T. (2025). Optimizing Drug-Resistant Tuberculosis Treatment Outcomes in a High HIV-Burden Setting: A Study of Sputum Conversion and Regimen Efficacy in Rural South Africa. Pathogens, 14.","DOI":"10.20944\/preprints202503.1361.v1"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.amsu.2020.11.032","article-title":"Impact of HIV status and predictors of successful treatment outcomes among tuberculosis patients: A six-year retrospective cohort study","volume":"60","author":"Fekadu","year":"2020","journal-title":"Ann. Med. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Baluku, J.B., Mukasa, D., Bongomin, F., Stadelmann, A., Nuwagira, E., Haller, S., and Ntabadde, K. (2021). Gender differences among patients with drug resistant tuberculosis and HIV co-infection in Uganda: A countrywide retrospective cohort study. BMC Infect. Dis., 21.","DOI":"10.1186\/s12879-021-06801-5"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"14144","DOI":"10.1038\/s41598-025-97027-x","article-title":"Treatment outcomes and predictors of success for multidrug resistant tuberculosis MDR TB in Ugandan regional referral hospitals","volume":"15","author":"Barteka","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"34370","DOI":"10.1038\/s41598-025-17061-7","article-title":"Determinants of treatment success and cost implications in MDR\/RR-TB patients: A prospective cohort study in China","volume":"15","author":"Tian","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Mbuh, T.P., Mendjime, P., Goupeyou-Wandji, I.A., Donkeng-Donfack, V.F., Kahou, J., Endale Mangamba, L.M., Mefoug, S., Bisso Ngono, P.A., Esso, L., and Etoundi Mballa, G.A. (2024). Trends of drug-resistant tuberculosis and risk factors to poor treatment-outcome: A database analysis in Littoral region-Cameroon, 2013\u20132022. BMC Public Health, 24.","DOI":"10.1186\/s12889-024-20585-8"},{"key":"ref_31","unstructured":"World Health Organization (2020). Global Tuberculosis Report 2020: Executive Summary, World Health Organization."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Safaev, K., Parpieva, N., Liverko, I., Yuldashev, S., Dumchev, K., Gadoev, J., Korotych, O., and Harries, A.D. (2021). Trends, Characteristics and Treatment Outcomes of Patients with Drug-Resistant Tuberculosis in Uzbekistan: 2013\u20132018. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18094663"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"5429","DOI":"10.2147\/IDR.S339972","article-title":"Risk Factors for Poor Outcomes Among Patients with Extensively Drug-Resistant Tuberculosis (XDR-TB): A Scoping Review","volume":"14","author":"Varshney","year":"2021","journal-title":"Infect. Drug Resist."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1164\/rccm.202410-2096ST","article-title":"Updates on the treatment of drug-susceptible and drug-resistant tuberculosis: An official ATS\/CDC\/ERS\/IDSA clinical practice guideline","volume":"211","author":"Saukkonen","year":"2025","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1016\/j.cmi.2023.12.001","article-title":"Treatment outcomes and risk factors for an unsuccessful outcome among patients with highly drug-resistant tuberculosis in Ukraine","volume":"30","author":"Pedersen","year":"2024","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Nidoi, J., Muttamba, W., Walusimbi, S., Imoko, J.F., Lochoro, P., Ictho, J., Mugenyi, L., Sekibira, R., Turyahabwe, S., and Byaruhanga, R. (2021). Impact of socio-economic factors on Tuberculosis treatment outcomes in north-eastern Uganda: A mixed methods study. BMC Public Health, 21.","DOI":"10.1186\/s12889-021-12056-1"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Ngari, M.M., Rashid, M.A., Sanga, D., Mathenge, H., Agoro, O., Mberia, J.K., Katana, G.G., Vaillant, M., and Abdullahi, O.A. (2023). Burden of HIV and treatment outcomes among TB patients in rural Kenya: A 9-year longitudinal study. BMC Infect. Dis., 23.","DOI":"10.1186\/s12879-023-08347-0"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Ngala, S.M., Tantoh, D.M., Nfor, O.N., Francis, G.D., Fitame, A., and Chu, Y.W. (2025). Age-specific relationship between HIV and TB treatment outcomes in the West Region of Cameroon: A cross-sectional study. BMC Infect. Dis., 25.","DOI":"10.1186\/s12879-025-10860-3"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Faye, L.M., Dlatu, N., Hosu, M.C., Chitha, W.W., and Apalata, T. (2026). Community-engaged clinical governance and machine learning for optimizing tuberculosis management in rural Eastern Cape. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1713401"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/4\/474\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T04:50:10Z","timestamp":1775883010000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/4\/474"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,9]]},"references-count":39,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["ijerph23040474"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23040474","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,9]]}}}