{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T21:44:15Z","timestamp":1788903855399,"version":"build-2803163510"},"reference-count":58,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T00:00:00Z","timestamp":1745971200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"South African Medical Research Council"},{"name":"Walter Sisulu University"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Background: Sputum culture and smear conversion are key indicators of treatment response in drug-resistant tuberculosis (DR-TB). This study aimed to assess sputum conversion and regimen efficacy among DR-TB patients and identify factors influencing conversion rates. Methods: This retrospective cohort study analyzed medical records of DR-TB patients treated between 2018 and 2020 in the Eastern Cape Province, South Africa. Kaplan\u2013Meier curves, Spearman correlation, and logistic regression models were used to assess time-to-sputum conversion and its predictors. Results: Among the 88% of patients who achieved sputum conversion, the median time ranged from 29 to 59 days. Patients on short treatment regimens converted significantly faster than those on long regimens (p = 7.55 \u00d7 10\u221215), with 90% of short-regimen patients achieving favorable outcomes compared to 52% in the long regimen group (p = 0.0000040). Spearman correlation revealed a weak but significant positive association between comorbidities and conversion time (r = 0.041, p = 0.041). HIV-positive patients had a slower conversion rate than HIV-negative patients, but this association was not statistically significant (\u03c72 = 0.426, p = 0.514). Logistic regression identified older age as a predictor of favorable outcomes (coefficient = 0.039, p = 0.045), while regimen type and HIV status did not show significant predictive power. Conclusions: Shorter treatment regimens significantly improve sputum conversion rates and treatment outcomes. The findings support optimizing DR-TB treatment through personalized regimens based on patient health status and drug resistance patterns. This study provides evidence to enhance TB control efforts in high-burden regions, with implications for global treatment strategies.<\/jats:p>","DOI":"10.3390\/pathogens14050441","type":"journal-article","created":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T07:44:58Z","timestamp":1746171898000},"page":"441","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Optimizing Drug-Resistant Tuberculosis Treatment Outcomes in a High HIV-Burden Setting: A Study of Sputum Conversion and Regimen Efficacy in Rural South Africa"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0388-787X","authenticated-orcid":false,"given":"Mojisola Clara","family":"Hosu","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, Faculty of Medicine and Health Sciences, Walter Sisulu University, Private Bag X5117, Mthatha 5099, 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":"Department of Laboratory Medicine and Pathology, Faculty of Medicine and Health Sciences, Walter Sisulu University, Private Bag X5117, 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 Medicine and Health Sciences, Walter Sisulu University, Private Bag X5117, Mthatha 5099, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e145107","DOI":"10.1172\/JCI145107","article-title":"Visualizing the dynamics of tuberculosis pathology using molecular imaging","volume":"131","author":"Ordonez","year":"2021","journal-title":"J. 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