{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T15:03:37Z","timestamp":1774278217308,"version":"3.50.1"},"posted":{"date-parts":[[2026,3,20]]},"group-title":"Public and Global Health","reference-count":35,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,3,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Despite global progress in tuberculosis (TB) control, treatment outcomes remain suboptimal, particularly in high-burden settings and among people with HIV or drug-resistant TB. Identifying predictors of unsuccessful treatment is essential to improve TB care and policy.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We evaluated TB treatment outcomes and patient characteristics associated with unsuccessful outcomes in five cohorts of the International epidemiology database to evaluate AIDS (IeDEA); Center for Infectious Disease Research, Zambia; Chiure health center, Mozambique; Martin Preuss Center, Lighthouse clinic, Malawi; Masvingo health center Zimbabwe; and Themba Lethu clinic, Hellen Joseph hospital, South Africa. We included all patients with TB aged \u2265 15 years starting TB treatment and assessed their treatment outcomes in association with sociodemographic and clinical characteristics using multivariable mixed-effects models. Unsuccessful outcomes were defined as death, loss to follow-up and treatment failure.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 1438 people with TB, median age was 39 years, 67% males, 40% with HIV, and 4% with MDR-TB; 1151 (80%) treatment outcomes were successful (606 cured and 545 completed treatment), 221 (15%) unsuccessful (89 deaths, 129 loss to follow-up and 3 treatment failures), and 66 (5%) other (49 unknown and 17 transfer-outs). Unsuccessful outcomes were more probable among people with multidrug-resistant TB (MDR-TB) and among participants without formal education. Risk of death was lower for people with bacteriologically confirmed TB (adjusted odds ratio (aOR) 0.5, 95%-credible interval [CI] 0.25-0.80), those with a secondary or higher education (aOR 0.3, 95%-CI 0.13-0.69) and BMI \u226518 kg\/m\u00b2 (aOR 0.6, 95%-CI 0.36-0.99). MDR-TB was associated with an increase (aOR 2.4 95%-CI 1.17-4.97) and primary and secondary or higher education with a decrease in loss to follow-up (aOR 0.3, 95%-CI 0.14-0.89 and aOR 0.3, 95%-CI 0.11-0.67, respectively).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>TB treatment outcomes fell short of the targets set by the World Health Organization of &lt;10% unsuccessful outcomes, indicating a critical need for enhanced management strategies. Tackling loss to follow-up is crucial, especially among MDR-TB patients, including stronger retention activities and improved diagnostic capacities.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.03.18.26348675","type":"posted-content","created":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T03:10:20Z","timestamp":1774062620000},"source":"Crossref","is-referenced-by-count":0,"title":["Evaluating tuberculosis treatment outcomes and predictors in five Southern African countries: A multi-country cohort analysis"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3836-914X","authenticated-orcid":false,"given":"Mirriam","family":"Ndhlovu","sequence":"first","affiliation":[{"name":"Lighthouse Trust, Lilongwe, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3990-3262","authenticated-orcid":false,"given":"Leticia","family":"Wuethrich","sequence":"additional","affiliation":[{"name":"Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacqueline","family":"Huwa","sequence":"additional","affiliation":[{"name":"Lighthouse Trust, Lilongwe, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agness","family":"Thawani","sequence":"additional","affiliation":[{"name":"Lighthouse Trust, Lilongwe, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geldert","family":"Chiwaya","sequence":"additional","affiliation":[{"name":"Lighthouse Trust, Lilongwe, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aubrey","family":"Kudzala","sequence":"additional","affiliation":[{"name":"Lighthouse Trust, Lilongwe, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Chintedza","sequence":"additional","affiliation":[{"name":"Lighthouse Trust, Lilongwe, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guy","family":"Muula","sequence":"additional","affiliation":[{"name":"Center for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denise","family":"Evans","sequence":"additional","affiliation":[{"name":"Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Idiovino","family":"Rafael","sequence":"additional","affiliation":[{"name":"SolidarMed, Chiure, Mozambique"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cordelia","family":"Kunzekwenyika","sequence":"additional","affiliation":[{"name":"SolidarMed, Masvingo, Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fiona","family":"Mureithi","sequence":"additional","affiliation":[{"name":"Center for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6010-2867","authenticated-orcid":false,"given":"Nelly","family":"Jinga","sequence":"additional","affiliation":[{"name":"Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amina","family":"Fernando","sequence":"additional","affiliation":[{"name":"SolidarMed, Chiure, Mozambique"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie","family":"Ballif","sequence":"additional","affiliation":[{"name":"Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland"},{"name":"Department of Infectious Diseases, Inselspital, Bern University Hospital, University Bern, Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gunar","family":"G\u00fcnther","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Allergology and Clinical immunology, Inselspital, University Hospital of Bern, Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3309-4835","authenticated-orcid":false,"given":"Lukas","family":"Fenner","sequence":"additional","affiliation":[{"name":"Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0138-6120","authenticated-orcid":false,"given":"Nicolas","family":"Banholzer","sequence":"additional","affiliation":[{"name":"Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland"},{"name":"Department of Public Health, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2026032307150463000_2026.03.18.26348675v1.1","unstructured":"Global Tuberculosis Report 2023. 1st ed. Geneva: World Health Organization; 2023. 57 p."},{"issue":"1","key":"2026032307150463000_2026.03.18.26348675v1.2","doi-asserted-by":"crossref","first-page":"20714","DOI":"10.7448\/IAS.19.1.20714","article-title":"TB as a cause of hospitalization and in-hospital mortality among people living with HIV worldwide: a systematic review and meta-analysis","volume":"19","year":"2016","journal-title":"Journal of the International AIDS Society"},{"key":"2026032307150463000_2026.03.18.26348675v1.3","unstructured":"The end TB strategy [Internet]. [cited 2025 Sep 30]. Available from: https:\/\/www.who.int\/publications\/i\/item\/WHO-HTM-TB-2015.19"},{"key":"2026032307150463000_2026.03.18.26348675v1.4","unstructured":"World Health Organization. Global Tuberculosis report 2025. Geneva; 2025 p. 59."},{"key":"2026032307150463000_2026.03.18.26348675v1.5","unstructured":"Global Tuberculosis Report 2021. 1st ed. Geneva: World Health Organization; 2021. 1 p."},{"issue":"20","key":"2026032307150463000_2026.03.18.26348675v1.6","doi-asserted-by":"crossref","first-page":"10678","DOI":"10.3390\/ijerph182010678","article-title":"Tuberculosis Treatment Outcome and Predictors in Africa: A Systematic Review and Meta-Analysis","volume":"18","year":"2021","journal-title":"IJERPH"},{"issue":"1","key":"2026032307150463000_2026.03.18.26348675v1.7","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1186\/s12879-024-09417-7","article-title":"Predictors of unsuccessful tuberculosis treatment outcomes in Brazil: an analysis of 259,484 patient records","volume":"24","year":"2024","journal-title":"BMC Infect Dis"},{"issue":"1","key":"2026032307150463000_2026.03.18.26348675v1.8","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1186\/s12916-025-04321-6","article-title":"Mental, physical, and respiratory health in people with tuberculosis in Southern Africa: a multi-country cohort analysis","volume":"23","year":"2025","journal-title":"BMC Med"},{"key":"2026032307150463000_2026.03.18.26348675v1.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"2026032307150463000_2026.03.18.26348675v1.10","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00804-2021"},{"issue":"9","key":"2026032307150463000_2026.03.18.26348675v1.11","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1159\/000516392","article-title":"Defining Outcomes of Tuberculosis (Treatment): From the Past to the Future","volume":"100","year":"2021","journal-title":"Respiration"},{"key":"2026032307150463000_2026.03.18.26348675v1.12","unstructured":"Global Tuberculosis Report 2020. 1st ed. Geneva: World Health Organization; 2020. 208 p."},{"issue":"4","key":"2026032307150463000_2026.03.18.26348675v1.13","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","year":"2021","journal-title":"Journal of Public Health"},{"issue":"10","key":"2026032307150463000_2026.03.18.26348675v1.14","doi-asserted-by":"crossref","first-page":"e0206227","DOI":"10.1371\/journal.pone.0206227","article-title":"Poor treatment outcomes and its determinants among tuberculosis patients in selected health facilities in East Wollega, Western Ethiopia","volume":"13","year":"2018","journal-title":"PLoS ONE"},{"issue":"1","key":"2026032307150463000_2026.03.18.26348675v1.15","doi-asserted-by":"crossref","first-page":"e0314693","DOI":"10.1371\/journal.pone.0314693","article-title":"Tuberculosis treatment outcomes and associated factors among patients treated at Bosaso TB Hospital, Bosaso, Somalia: A five-year retrospective study","volume":"20","year":"2025","journal-title":"PLoS ONE"},{"issue":"1","key":"2026032307150463000_2026.03.18.26348675v1.16","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1186\/s12889-020-08841-z","article-title":"Tuberculosis treatment outcomes among prisoners and general population in Zomba, Malawi","volume":"20","year":"2020","journal-title":"BMC Public Health"},{"issue":"8","key":"2026032307150463000_2026.03.18.26348675v1.17","doi-asserted-by":"crossref","first-page":"e0000152","DOI":"10.1371\/journal.pgph.0000152","article-title":"Factors associated with poor treatment outcomes among tuberculosis patients in Kyangwali Refugee Settlement, Uganda, 2016\u20132017","volume":"2","year":"2022","journal-title":"PLOS Glob Public Health"},{"key":"2026032307150463000_2026.03.18.26348675v1.18","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2024-017828"},{"key":"2026032307150463000_2026.03.18.26348675v1.19","doi-asserted-by":"crossref","unstructured":"Ankunda C , Emunyu J , Namasambi S , Sserunjogi C , Kyomuhangi B , Mumbere I , et al. Evolving profiles and treatment success predictors among tuberculosis patients in Uganda from 2019 to 2023: a registry based study. BMC Infect Dis. 2026 Feb 14;","DOI":"10.1186\/s12879-026-12887-6"},{"key":"2026032307150463000_2026.03.18.26348675v1.20","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002595"},{"issue":"7","key":"2026032307150463000_2026.03.18.26348675v1.21","doi-asserted-by":"crossref","first-page":"731","DOI":"10.5588\/ijtld.17.0596","article-title":"Dalcin R. Interventions to improve adherence to tuberculosis treatment: systematic review and meta-analysis","volume":"22","year":"2018","journal-title":"int j tuberc lung dis"},{"key":"2026032307150463000_2026.03.18.26348675v1.22","doi-asserted-by":"crossref","first-page":"103251","DOI":"10.1016\/j.eclinm.2025.103251","article-title":"Clinically diagnosed tuberculosis and mortality in high burden settings: a systematic review and meta-analysis","volume":"84","year":"2025","journal-title":"eClinicalMedicine"},{"key":"2026032307150463000_2026.03.18.26348675v1.23","unstructured":"Global Tuberculosis Report 2024. 1st ed. Geneva: World Health Organization; 2024. 50 p."},{"issue":"1","key":"2026032307150463000_2026.03.18.26348675v1.24","doi-asserted-by":"crossref","first-page":"e00031721","DOI":"10.1590\/0102-311x00031721","article-title":"Educational level and tuberculosis mortality in Colombia: growing inequalities and stagnation in reduction","volume":"38","year":"2022","journal-title":"Cad Saude Publica"},{"key":"2026032307150463000_2026.03.18.26348675v1.25","doi-asserted-by":"publisher","DOI":"10.1177\/2325957413488185"},{"key":"2026032307150463000_2026.03.18.26348675v1.26","doi-asserted-by":"crossref","first-page":"S50","DOI":"10.1016\/j.ijid.2022.07.067","article-title":"Tobacco smoking impact on tuberculosis treatment outcome: an observational study from West Africa","volume":"124","year":"2022","journal-title":"International Journal of Infectious Diseases"},{"key":"2026032307150463000_2026.03.18.26348675v1.27","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0239333"},{"key":"2026032307150463000_2026.03.18.26348675v1.28","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.19.0002"},{"key":"2026032307150463000_2026.03.18.26348675v1.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2023.08.021"},{"issue":"1","key":"2026032307150463000_2026.03.18.26348675v1.30","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1186\/s12890-024-03350-w","article-title":"Multidrug-resistant tuberculosis treatment outcomes and associated factors at Yirgalem General Hospital, Sidama Region, South Ethiopia: a retrospective cohort study","volume":"24","year":"2024","journal-title":"BMC Pulm Med"},{"key":"2026032307150463000_2026.03.18.26348675v1.31","unstructured":"CDC. Tuberculosis (TB). 2025 [cited 2025 Sep 30]. About Drug-Resistant Tuberculosis Disease. Available from: https:\/\/www.cdc.gov\/tb\/about\/drug-resistant.html"},{"issue":"1","key":"2026032307150463000_2026.03.18.26348675v1.32","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1186\/s12890-021-01735-9","article-title":"Determinant factors for loss to follow-up in drug-resistant tuberculosis patients: the importance of psycho-social and economic aspects","volume":"21","year":"2021","journal-title":"BMC Pulm Med"},{"key":"2026032307150463000_2026.03.18.26348675v1.33","doi-asserted-by":"crossref","first-page":"100278","DOI":"10.1016\/j.jctube.2021.100278","article-title":"Gaps related to screening and diagnosis of tuberculosis in care cascade in selected health facilities in East Africa countries: A retrospective study","volume":"25","year":"2021","journal-title":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases"},{"key":"2026032307150463000_2026.03.18.26348675v1.34","doi-asserted-by":"crossref","first-page":"109397","DOI":"10.1016\/j.cbi.2021.109397","article-title":"Multidrug resistant tuberculosis \u2013 Diagnostic challenges and its conquering by nanotechnology approach \u2013 An overview","volume":"337","year":"2021","journal-title":"Chemico-Biological Interactions"},{"issue":"01","key":"2026032307150463000_2026.03.18.26348675v1.35","doi-asserted-by":"crossref","first-page":"001","DOI":"10.4103\/0974-2727.154778","article-title":"Challenges in Tuberculosis Diagnosis and Management: Recommendations of the Expert Panel","volume":"7","year":"2015","journal-title":"J Lab Physicians"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.03.18.26348675","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T14:15:20Z","timestamp":1774275320000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.64898\/2026.03.18.26348675"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,20]]},"references-count":35,"URL":"https:\/\/doi.org\/10.64898\/2026.03.18.26348675","relation":{},"subject":[],"published":{"date-parts":[[2026,3,20]]},"subtype":"preprint"}}