Mohd Khairi Safwan JOHARI, Aziah DAUD, Ijlal Syamim Mohd BASRI, Hasniza ABDULLAH
Infectious Diseases and Clinical Microbiology - 2026;8(4):372-383
Objective: Unfavorable pulmonary tuberculosis (PTB) treatment outcomes remain a critical indicator of program performance because they are linked to preventable mortality, ongoing transmission, and potential amplification of drug resistance. This study aimed to determine the proportion of unfavorable treatment outcomes and identify factors associated with these outcomes among PTB patients in Kelantan, Malaysia. Materials and Methods: A retrospective registry-based cohort study was conducted using data from the National Tuberculosis Registry in Kelantan covering the period from 2013 to 2022. A simple random sample of 1260 eligible PTB patients was selected. Unfavorable outcomes were defined as treatment failure, death, or loss to follow-up. Candidate predictors included sociodemographic characteristics, comorbidity indicators, clinical characteristics, and the type of directly observed treatment, short-course (DOTS) supervision. Univariable and multivariable logistic regression analyses were performed to identify factors associated with unfavorable outcomes. Results: The proportion of unfavorable outcomes was 20.8% (262/1,260). In multivariable analysis, HIV-positive status was strongly associated with unfavorable outcomes (adjusted odds ratio [AOR], 5.69; 95% confidence interval [CI], 3.78-8.57; p < 0.001). Multidrug-resistant tuberculosis (MDR-TB) was also associated with increased odds of unfavorable outcomes (AOR, 5.69; 95% CI, 2.40-13.52; p < 0.001). Compared with DOTS supervised by healthcare workers, family-supervised DOTS was associated with higher odds of unfavorable outcomes (AOR 5.02; 95% CI, 1.73-14.59; p = 0.003). Conclusion: Approximately one in five PTB patients experienced an unfavorable treatment outcome in Kelantan. Unfavorable outcomes were concentrated among patients with HIV infection and MDR-TB and were more frequent among those receiving family-supervised DOTS. These findings support risk-stratified care, strengthened TB-HIV integration, intensified MDR-TB case management, and improved support and accountability for family-based DOTS supervision.
