Predictors of unsuccessful treatment outcomes among adults with pulmonary tuberculosis in a resource-limited setting

Abstract

Introduction: Tuberculosis (TB) remains a major health burden in low- and middle-income countries, where successful treatment is central to control efforts. This study aimed to determine the predictors of unsuccessful TB treatment in a resource-limited setting.Method: A retrospective, record-based study was conducted at a district general hospital in Banten Province, Indonesia, and included 231 adults with  pulmonary TB who were registered between January 2020 and December 2023. Outcomes were classified as successful (cured or treatment completed) or unsuccessful (treatment failure, loss to follow-up, or death) according to WHO definitions. Factors associated with unsuccessful outcome were assessed using chi-square tests, and variables with p < 0.25 were enteredinto a multivariable logistic regression model.Results: Of 231 patients, 34 (14.7%) had an unsuccessful treatment outcome, comprising 18 deaths, 11 lost to follow-up, and 5 treatment failures. Independent predictors of unsuccessful outcome were age ≥60 years (adjusted odds ratio [aOR] 2.81, 95% CI 1.14–6.92), underweight nutritional status (aOR 2.47, 95% CI 1.08–5.65), previously treated TB (aOR 3.56, 95% CI 1.39–9.11), and HIV-positive status (aOR 5.74, 95% CI 1.71–19.24). HIV-positive status demonstrated the strongest association with unsuccessful treatment outcome.Conclusion: Older age, undernutrition, retreatment, and HIV co-infection independently predicted unsuccessful TB treatment outcomes in this district setting. These factors help frontline clinicians to identify high-risk patients early and target nutritional support, integrated TB-HIV care, and closer monitoring.