Time to a Tuberculosis Treatment Cure and Its Predictors among Tuberculosis Patients at Public Health Facilities in Arbaminch Town, South Ethiopia: A Retrospective Cohort Study

Time to a Tuberculosis Treatment Cure and Its Predictors among Tuberculosis Patients at Public Health Facilities in Arbaminch Town, South Ethiopia: A Retrospective Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Time to a Tuberculosis Treatment Cure and Its Predictors among Tuberculosis Patients at Public Health Facilities in Arbaminch Town, South Ethiopia: A Retrospective Cohort Study Dereje Dana, Mesfin Kote, Eshetu Zerihun, Getahun Gedabo, Biruk Wogayehu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5919462/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Jul, 2025 Read the published version in BMC Infectious Diseases → Version 1 posted 8 You are reading this latest preprint version Abstract Introduction : The WHO's 2022 Global Tuberculosis Report shows that TB causes 1.3 million deaths annually, including 167,000 TB-HIV confections. It affects 10.6 million people, mainly in Asia and Africa, 75% of whom are in the economically active age group of 15--54 years. Treatment interruptions hinder efforts to eliminate TB by 2030. According to a recent systematic review conducted using Ethiopian studies indicated that the pooled prevalence of TB treatment cure rate was 33.9%. There is a lack of evidence on time to TB treatment cure in Ethiopia using survival analysis. Objective : This study aimed to determine the time to TB treatment cure and its predictors among tuberculosis patients from January 2021 to December 2023 at public health facilities in Arba Minch town. South Ethiopia. Method: An institution-based retrospective cohort study was conducted among 628 selected TB patients who were admitted to the TB care unit at Arba Minch General Hospital, Dilfana Primary Hospital, and both health centers from 2021 to 2023. A Kaplan Meier survival curve was fitted to test the survival time. The Cox proportional hazards model was used to identify predictors with TB treatment cure. Significance was considered at a p value ≤ 0.05 with an adjusted hazard ratio (HR) 95% CI in the multivariate analysis. Results : Out of the 628 patients whose records were analyzed, the median time to cure was 162 days. The significant predictors of time to TB cure included being male (AHR 0.3, 95% CI: 0.35–0.95), history of TB treatment (AHR 0.56, 95% CI: 0.35–0.95), and normal BMI (AHR 1.04, 95% CI: 1.32–1.49). Conclusions : Female sex, a history of TB treatment, increased weight, and health facility type were found to be independent predictors of time to cure. Therefore, working on these predicators to improve TB treatment is critical. Tuberculosis TB treatment cure time to TB treatment cure Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis that mostly affects the lungs [ 1 ]. Significant advancements have been made in the fight against tuberculosis (TB) across Africa, according to the 2023 Global TB. According to the WHO treatment guidelines, the essential anti-TB drugs are isoniazide, rifampicin, pyrazinamide, ethambutol, and streptomycin [ 2 ]. The first-line treatment for TB in Ethiopia is rifampicin (R), ethambutol (E), isoniazid (H), pyrazinamide (Z), and streptomycin (S). Drugs are available in fixed-dose combinations and are available as single drugs [ 2 ]. The treatment of TB has two phases: intensive (initial) and continuation. This phase consists of three or more drugs for the first 8 weeks for new cases and 12 weeks for retreated cases. During this phase, patients are given a combination of four first-line anti-TB drugs: isoniazid, rifampicin, pyrazinamide, and ethambutol. The continuation phase requires at least two drugs to be taken for 4–6 months. In this phase, medications are often self-administered by the patient, and they must collect their drugs monthly from a healthcare facility [ 2 ]. In the Global Tuberculosis Report of 2022 by the World Health Organization, 1.3 million people died from TB globally [ 3 ]. A total of 10.6 million individuals worldwide are expected to have contracted tuberculosis in 2022, with the bulk of those cases occurring in the WHO Regions of Southeast Asia, Africa, and the Western Pacific. Significant TB (tuberculosis) obstacles were faced by the African area in 2022 [ 3 ]. In Africa, almost 2.5 million individuals are TB ill [ 3 ]. According a systematic review and meta-analysis showed that the pooled cure rate was 64.5% (95% CI 55.1–73.3%) which was obtained from 14 studies in Sub-Saharan Africa [ 4 ]. Among the 10,156 smear-positive PTB patients evaluated on DOTS in North Central Nigeria, 20.1% were cured at the end of treatment [ 5 ]. Another study in Nigeria reported treatment cure rates of 61.5% in patients under facility-based DOTS [ 6 ]. A retrospective follow study conducted in Ghana revealed that the cure rate of TB patients was 30.7% [ 7 ]. In 2023, Ethiopia made significant progress in reducing the incidence of tuberculosis (TB) by approximately 34% since 2015, according to the 2023 Global TB Report by the World Health Organization (WHO). However, the country continues to have a high total incidence of TB 165 per 100,000 people [ 8 ]. Ethiopia was one of the seven countries that achieved the 2021 milestones of the WHO's End TB Strategy [ 9 ]. A recent systematic review and meta-analysis of studies conducted in Ethiopia reported a pooled tuberculosis treatment cure rate of 33.9% (95% CI: 26.3–41.5%) [ 10 ]. Retrospective follow-up studies conducted in different regions of Ethiopia have reported variable cure rates: 85.5% in the Tigray region [ 11 ], 33.7% in Eastern Ethiopia [ 12 ], 27.5% in Southern Ethiopia [ 13 ], and 12.6% in Northwestern Ethiopia [ 14 ]. The majority of studies conducted in sub-Saharan Africa, including those from Ethiopia [ 4 – 7 , 10 – 14 ], have not assessed the time to tuberculosis treatment cure using survival analysis, limiting insights into the temporal dynamics of recovery. To reach global target of treatment success rate of at least 90% for all forms of TB by 2035 [ 15 ], evaluating time to TB treatment cure is essential for assessing the efficacy of treatment interventions and ensuring the best possible patient outcomes. Our findings are critical for reducing the impact of TB by identifying potential predictors that influence the time to TB treatment cure. Therefore, our study aimed to determine time to TB treatment cure and its predictors among TB patients in all public health facilities in Arbaminch Town for the period from January 2021 to December 2023. Methods and materials Study Area and period Arba Minch town is the capital town of the Gamo zone. It is located 505 kms from Addis Ababa (capital city of Ethiopia). The town is one of the lowlands in southern Ethiopia and has a hot climate with an average temperature of 29°C and annual mean rainfall of 900 mm. The town has 2 subdivisions: Secha and Sikela, each 5 kms apart, and the town has a total population of 125,411. There are four public health facilities in the town: Arbaminch General Hospital, Dilfana Primary Hospital, Secha Health Center and Woze Health Center. The facilities serve more than four million people in Arba Minch town and neighboring zones. All facilities provide TB treatment services. The study included TB registrations from January 1, 2021, to December 30, 2023. Study design and population A facility-based retrospective cohort study design was conducted among adult TB patients aged 18 years and older, who were registered in the TB logbook from January 2021 to December 30, 2023. The source population consisted of TB patients who initiated treatment at public health facilities. The study population included TB patients registered in the TB logbook from January 2021 to December 30, 2023, at Arbaminch General Hospital, Dilfana Primary Hospital, Secha Health Center and Woze Health Center. Eligibility criteria Inclusion This study included the records of all TB patients registered at Arbaminch General Hospital, Dilfana Primary Hospital, Secha Health Center and Woze Health Center from January 2021 to December 2023, who were bacteriologically positive using Gene Xpert. Exclusion Patients were excluded if they had incomplete medical records for at least one variable, were transferred to or from other healthcare facilities, were children, pregnant women, individuals with multidrug-resistant tuberculosis (MDR-TB), or had extra-pulmonary tuberculosis. Sample size determination The sample size was determined via two population proportion formulas via the Epi info version 7 stat calc program by considering the following assumptions: 95% CI, power 80%, ratio of unexposed to exposed 1:1, and parameters: outcome in exposed (sex client female) = 89.7%, outcome in unexposed (sex client male) = 72.9% [ 16 ], and AOR = 2.8. Accordingly, the calculated sample size for this study was 628 (Table 1 ). Table 1 -Sample size determination S.No Variables CI AOR Power AOR Sample size Loss to F/Up Final sample Reference 1. HIV stats 95% 3.9 80% 1 120 10% 132 [ 16 ] 2. Sex 95% 2.8 80% 1 572 10% 628 [ 16 ] Sampling technique Figure 1 shows sampling procedure to select patients registered in each facility’s TB logbook. TB patients were selected from the four health facilities using proportional allocation based on the number of patients registered in each facility’s TB logbook. Specifically, 268 patients were from Arbaminch General Hospital, 198 patients from Dilifana primary hospital, 85 patients from Secha Health Center, and 77 patients from Sikela Health Center. In this study, we employed a simple random sampling technique to recruit a predetermined sample size via the registration/card numbers of the enrolled clients. Computer-generated random numbers were utilized to select study participants' records from each consecutive year. From a total of 1097 TB patient records collected between January 1, 2021, and December 31, 2023, 628 samples were selected (Fig. 1). The necessary information was then extracted from these records, which were obtained from Arba Minch General Hospital, Dilfana Primary Hospital, Secha Health Center and Woze Health Center. Variables and measurement Dependent variable Time to TB treatment cure Status variable = 1 if cured and 0 = if not cured Independent variables History of treatment: New, previous history Patient category: New case,, retreatment HIV co-infection: TB/HIV co-infected, without co-infection Baseline characteristics and underlying illness, comorbidity, and adherence. Socio-demographic factors: Age, sex Anthropometric factors: Age, height and BMI Operational definition Time to cure : The time from anti-TB treatment initiation to cure during anti-TB therapy [ 17 ]. TB cure : A pulmonary TB patient with bacteriologically confirmed TB at the beginning of treatment who was smear- or culture-negative in the last month of treatment and had at least one previous occasion [ 17 ]. Treatment completed : A patient who completed treatment but without evidence of failure of BUT with no record of sputum or culture results in the last month of treatment and on at least one previous occasion was negative, either because tests were not performed or because the results were unavailable [ 17 ]. Treatment success : A sum of cured and completed treatment [ 17 ]. Censored cases : All patients whose TB treatment outcomes were terminated except for a cure during anti-TB treatment were included [ 17 ]. Retreatment cases : Have received 1 month or more of anti-TB drugs in the past [ 17 ]. Baseline body weight : The weight of the patients at the time of anti-TB treatment initiation. Data collection tool and procedure The source of data is individual patient record documents, including register monitoring cards and patient folders. Data were collected via a structured checklist or questionnaire using Koobo tool. The checklist included information on socio-demographic characteristics (age and sex), clinical and treatment-related variables (including history of treatment— new or previous history — and TB/HIV co-infection status, weight, height, BMI), HIV status, and treatment outcomes (cured, treatment completed, treatment failure, default, died, or transferred out). Data collection forms and appropriate modifications concerning this study were made. This is prepared in English. Data were collected by six diploma-level health professionals trained in clinical nursing, under the supervision of two BSc-level health professionals qualified as health officers. A one-day training session was provided to the data collectors by the principal investigator, covering the study objectives, participant selection procedures, confidentiality protocols, questionnaire content, data collection procedures, and data quality assurance measures. Each day following data collection, completed questionnaires were reviewed for completeness by the supervisor and the principal investigator, and feedback was provided to the data collectors the following day. Data quality management Data quality was assured by careful design of the data extraction formats, appropriate modifications, appropriate recruitment, and adequate training and follow-up for the data collectors and supervisors. The pretest was performed on 5% of the population (n = 31) at Arba Minch General Hospital (n = 23) and Arba Minch Dil Fana Primary Hospital (n = 8). The principal investigator and supervisor provided intensive supervision during the entire period of data collection. The principal investigator reviewed a random sample of registration forms to confirm the reliability of the data before data collection, and the investigators also made random cross-checks for completeness, accuracy, and consistency at the end of each day, corrective discussion was undertaken with all the research team members. During the morning hours, remarks were made regarding the techniques that can be utilized to remove or limit errors and to take remedial steps. The data were checked for completeness and consistency. Data processing and analysis After data collection, the data were downloaded from the Kobo tool in Excel format. Exported to STATA version 17 for analysis and data management, the data were then investigated to assess the extent of missing values, identify notable outliers, examine multicollinearity, evaluate normality, and determine the proportionality of hazards over time. Graphical and statistical methods such as the Kolmogorov–Smirnov test were applied to check the normality of the data. The Cox regression model for its fitness to the data and its adequacy was checked by graphing residual plots such as the Cox-Snell residual. A Kaplan–Meier survival curve together with the log-rank test was fitted to test the survival time of patients receiving TB treatment. Variables significant at the p < or equal to 0.25 level in the bivariate analysis, biological plausibility, and previous study were considered and included in the final Cox regression analysis to identify independent predictors of TB treatment cure. The crude hazard ratio, adjusted hazard ratio (adjusted hazard ratio), 95% CI, and P value were used to assess the strength of the associations and their statistical significance. Covariates were checked for interaction effects. The data are presented in the text, tables, and figures. Results Socio-demographic and clinical characteristics Table 2 shows the socio-demographic and clinical characteristics of participants. A total of 628 TB cards were reviewed. The mean age of the TB patients was 36.24 ( ± 5.7) years. The study included a total of 628 tuberculosis (TB) patients. The majority of patients (73.89%) were aged between 25 and 64 years, followed by those aged 15 to 24 years (16.40%) and those aged 65 years or older (9.71%). The sex distribution revealed that more female patients (54.14%) than male patients (45.86%) were included in the study population. Most of the patients were treated at primary health facilities (57.32%) rather than secondary health facilities (42.68%). The average weight of the patients was 59.96 kg (± 10.9), and the average height was 1.65 meters (± 0.8), with varying body mass index (BMI) values. Most of the patients (78.03%) had a normal BMI, whereas 12.58% and 9.39% were overweight and underweight, respectively. The great majority of the patients (94.27%) were new cases of TB, and only 5.73% of the patients had received previous TB treatment. Comorbidities were rare; only 1.76% of the patients were HIV positive and the other 98.25% were HIV negative (Table 2 ). Table 2 Socio-demographic and clinical characteristics of TB patients at a public health facility in Arbaminch town, South Ethiopia (n = 628) Variables Categories Frequency (n) Percent (%) Age of TB patients in years 15–24 103 16.40 25–64 464 73.89 Greater or equal to 65 61 9.71 Age (mean ± SD) 36.24 years ( ± 5.7) Sex of the TB patients Male 288 45.86 Female 340 54.14 Facility type Secondary health facility 268 42.68 Primary health facility 360 57.32 Wight in kg (mean ± SD) 59.96 ( ± 10.9) Height in meters (mean ± SD) 1.65( ± 0.8) BMI Underweight 59 9.39 Normal weight 490 78.03 Over weight 79 12.58 Patient category New case 592 94.27 Re-treatment 36 5.73 HIV co-infection HIV positive 11 1.75 HIV negative 617 98.25 Tuberculosis treatment outcomes of patients Table 3 indicates tuberculosis treatment outcomes. The study results demonstrate a very high cure rate of 91.24%, indicating effective tuberculosis (TB) management and treatment within the study population. The low percentages of deaths (1.27%), defaulters (2.23%), and patients requiring retreatment highlight good adherence to treatment protocols and successful healthcare interventions. However, a transfer-out rate of 3.98%, although not excessively high, suggests that a small number of patients need to be managed in different facilities (Table 3 ). Table 3 Tuberculosis treatment outcomes of patients outcome Frequency Percent Cured 573 91.24 Death 8 1.27 Defaulter 14 2.23 Transfer out 25 3.98 Retreatment 8 1.27 Survival analysis results The median survival time was 162 (95% CI: 158, 164) days, and the multicollinearity of the covariates in this study was measured by the variance inflation factor (VIF), which was 1.21. The time to cure tuberculosis (TB) is influenced by several key factors, including the type of healthcare facility, the patient's sex, the HIV status, and the treatment history. Patients treated in secondary health centers had a greater hazard of cure than did those treated in primary health centers, with an adjusted hazard ratio (AHR) of 1.69 (95% CI: 1.4, 2.00). The hazard of cure was 70% lower for male patients than for female patients (AHR = 0.3 (95% CI: 0.29, 0.433)). Compared with HIV-negative patients, patients without HIV had a greater hazard of cure but no statistically significant hazard of cure (AHR: 1.05; 95% CI: 0.4, 2.39). The hazard of cure was 44% lower for patients with a history of previous TB treatment than for new patients (AHR = 0.56 (95% CI: 0.35, 0.96)). A one-unit increase in weight increases the hazard of cure by 2% (95% CI: 1.01, 1.03). Patients with a normal BMI had a slightly greater hazard ratio for being cured than underweight patients did. The adjusted hazard ratio (AHR) of 1.04 indicates that, after adjusting for other variables, the hazard of being cured for normal weight patients is 4% greater than that for underweight patients. These findings highlight the impact of healthcare facility type, sex, BMI, comorbidity status, and treatment history on TB patient cure (Table 4 ). Table 4 Survival status of TB patients at a public health facility in Arbaminch town, Southern Ethiopia (n = 628) Variable (n = 628) Survival status CHR(95%CI) AHR(95%CI) P- values Cure N (%) Censored N(%) Facility Secondary health center 256(42.68) 12(18.75) 1.69(0.5, 0.7) 1.69(1.4, 2.00) 0.002 Primary health center 308(54.60) 52(81.25) 1 1 Sex Female 274(48.38) 14(21.88) 1 1 Male 290(51.42) 50(78.13) 0.4(0.39, 0.55) 0.3(0.29,0.43) 0.008 HIV co-infection HIV 6(1.08) 5(7.80) 1 1 Without HIV 558(98.96) 59(92.19) 1.13(1.50, 2.54) 1.05(0.4, 2.39) 0.09 Patient category New case 546(96.81) 46(71.88) 1 1 Re-treatment 18(3.19) 18(28.13) 0.48(0.3, 0.77) 0.56(0.35, 0.96) 0.001 BMI Under 50(8.87) 9(14.06) 1 1 Normal 438(77.66) 52(81.25) 1.01(1.23 1.45) 1.04(1.32 1.49) 0.003 Over 76(13.48) 3(4.69) 1.37(1.02 1.09) 1.37(1.02 1.09) 0.002 Time to cure of patients On the basis of the Kaplan‒Meier survival estimates, female patients are more likely to be cured than male patients (Fig. 2). The Cox proportional hazards regression plot in Fig. 3 presents the time to cure tuberculosis (TB) such that the survival probability begins at 1 (all patients ill) and decreases over time as patients are cured. In the beginning, after approximately 50 days, the survival curve is relatively flat, which means that few patients are cured at the beginning. There is a steep curve between 50 and 150 days, which means that there is a significant increase in the number of patients cured during this critical treatment phase. After 150 days, the curve continues to decline at a slower pace, which means that most patients have been cured, and by approximately 200 days, all patients have been cured. Thus, the plot demonstrated that the majority of patients achieved a cure between 50 and 150 days, with almost all patients cured by 200 days (Fig. 3). The Cox proportional hazards regression plot with the smoothed hazard function provides insight into the risk of being cured of tuberculosis (TB) over time. The Y-axis represents the smoothed hazard function, which indicates the instantaneous rate at which patients are cured, whereas the X-axis represents the analysis time in days. After 150 days, the hazard function increases sharply, indicating a significant increase in the rate at which patients are cured. This steep increase suggests that most patients achieve a cure during this period (Fig. 4). Discussion This study aimed to evaluate the time to cure status and predictors influencing the cure rate of tuberculosis (TB) patients admitted to public health facilities in Arba Minch town from 2021–2023. The median survival time in this study was 162 days, which is comparable to that reported in a similar study conducted in Mezan, Southwest Ethiopia, which reported a survival range of 156–180 days [ 18 ]. Differences in the study setting may account for the variations observed. The cure rate in our study was 91.24%, which exceeds the rates reported in studies from Nigeria (61.5%) [ 6 ], Ghana (30.7%) [ 7 ], and Sub-Saharan Africa overall (64.5%) [ 4 ]. Similarly, our cure rate was higher than those reported in studies from the Tigray region (85.5%) [ 11 ], Eastern Ethiopia (33.7%), Southern Ethiopia (27.5%) [ 13 ], and Northwestern Ethiopia (19.2%) [ 14 ]. These discrepancies may be attributed to variations in study design, geographic location, availability of tuberculosis (TB) medications, and access to TB care services. Moreover, our cure rate surpassed the World Health Organization (WHO) recommended standard of 90%, indicating that TB care services in our study area meet and exceed international performance benchmarks [ 15 ]. The study also indicated that the majority of cures occurred in secondary health facilities rather than primary health facilities. This observation can be attributed to Ethiopia's tiered healthcare system, which is structured into primary, secondary, and tertiary levels, each with distinct roles in delivering healthcare services. Primary health facilities, including health posts and centers, focus on preventive, promotive, and basic curative services and are designed to be accessible to rural populations [ 19 , 20 ]. In contrast, secondary health facilities provide more specialized care, including surgical procedures and inpatient care for serious illnesses, and typically cater to patients referred from primary facilities. Compared with males, females exhibit better survival outcomes. A study conducted in Europe revealed that men are significantly more likely to die from TB than women are [ 21 ]. This disparity could be linked to the greater likelihood of men having comorbid conditions such as smoking-related illnesses or other chronic diseases that complicate TB treatment and worsen survival outcomes. Studies indicate higher on-treatment mortality rates for male patients due to these additional health challenges [ 22 ]. Patients with a history of previous TB treatment had poorer survival outcomes than those who were receiving treatment for the first time. Research shows that previously treated patients face a significantly greater risk of adverse outcomes, including lower treatment success rates and higher rates of complications [ 23 ]. Underweight patients account for a significant proportion of tuberculosis (TB) cases because several interrelated factors impair their immune response and increase susceptibility to the disease. Research indicates that individuals with a body mass index (BMI) less than 18.5 are at markedly greater risk for developing TB, as underweight status is associated with compromised immune function. For example, a study reported that the risk of TB incidence increased with increasing severity of underweight, with adjusted hazard ratios indicating that individuals with mild, moderate, and severe thinness had 1.98, 2.50, and 2.83 times greater risks of developing TB, respectively, than individuals with normal weight [ 24 , 25 ]. Weight has been shown to be significantly associated with treatment outcomes in tuberculosis (TB) patients, with higher weight correlating with improved cure rates. A consistent study conducted in Northwest Ethiopia revealed that patients who gained weight during TB treatment had better outcomes [ 26 ]. This is because proper nutrition strengthens the immune system, which is crucial for fighting infections. These findings provide valuable insights into the factors influencing TB treatment outcomes in Arba Minch and underscore the importance of addressing specific patient needs and healthcare system structures to improve survival rates and overall treatment success. Limitations of the study The study's retrospective cohort design led to the exclusion of several important variables, such as socio-demographic and socioeconomic factors, including dietary intake, wealth status, educational level, and distance to healthcare facilities. Additionally, this study focused exclusively on pulmonary tuberculosis (TB), and therefore, the findings may not be generalizable to patients with extra pulmonary TB. Furthermore, bacteriologically positive patients were identified using the GeneXpert assay; however, culture results were not considered in this study. Conclusions In conclusion, female sex, history of TB treatment, increased weight, and type of health facility were found to be independent predictors of a cure, and the median recovery time was 162. Therefore, working on these predictors to improve TB treatment cure is critical. This comprehensive analysis of TB patient characteristics is crucial for improving patient management and care continuity. Additionally, considering the observed sex differences, tailored strategies to address the specific needs of male patients may further enhance treatment outcomes. Further prospective cohort studies are also recommended to explore the underlying mechanisms influencing these predictors of time to TB cure. Abbreviations AFB Acid-fast bacilli AHR Adjusted hazard ratio CHR Crude hazard ratio CI Confidence interval DOTs Directly observed therapies EPTB Extra pulmonary tuberculosis PTB Pulmonary tuberculosis TB Tuberculosis WHO World Health Organization Declarations Ethics approval and consent to participate An ethical clearance letter was obtained from Arbaminch University's institutional review board (Protocol No.: DD23258). Prior to data collection, the administrations of Arba Minch General Hospital, Arba Minch Dil Fana Primary Hospital, Secha Health Center and Woze Health Center were informed about the study objectives and procedures. Permission for the study was obtained from the hospital administrations. Upon completion of data collection, the records were returned to the registry and stored on the designated shelves without disrupting the routine operations of the center. The data collection forms did not include any personally identifiable information, such as patient names, addresses, telephone numbers, or the names of the healthcare providers. Additionally, confidentiality was maintained by using anonymous tool and ensuring that all data were securely stored. Consent for publication Not applicable. Availability of the data and materials The datasets of the study are available on reasonable request from the corresponding author. Competing interest The authors declare that they have no competing interests. Funding Not applicable. Authors’ contributions All authors were involved in the conception of the study, design, data acquisition, data analysis and interpretation. The manuscript was also developed through active participation of all authors. Acknowledgments We would like to thank our colleagues who gave useful advice on the completion of this research. References WHO. Global tuberculosis report 2024. Geneva: World Health Organization; 2024. 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Cite Share Download PDF Status: Published Journal Publication published 01 Jul, 2025 Read the published version in BMC Infectious Diseases → Version 1 posted Editorial decision: Revision requested 12 May, 2025 Reviews received at journal 10 May, 2025 Reviews received at journal 05 May, 2025 Reviewers agreed at journal 05 May, 2025 Reviewers agreed at journal 30 Apr, 2025 Reviewers invited by journal 30 Apr, 2025 Submission checks completed at journal 29 Apr, 2025 First submitted to journal 28 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5919462","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":450169507,"identity":"8b98f078-c980-4d4f-8194-22bc4ea847b5","order_by":0,"name":"Dereje Dana","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/0lEQVRIiWNgGAWjYDCCA0DMA8SMDYwNBz4AGWzsxGthPnhwBkgLM7FagGqTD4MZhLTwHT978MObintyzO09Bodtfm2T52NmYPzwMQe3FskzecmSc84UGzP2nDE4nNt327CNmYFZcuY23FoMDuQYSPO2JSQ2zsgBaum5zQjUwsbMi0/L+TfGv3n/JdQ3zn9jcNiy57Y9YS03csykeRsSEhhnsCUcZvhxO5GgFskbb8ws5xxLMGzsST5wsLfhdnIbM2MzXr/wnc8xvvGmJkHesP1g84cff27bzm9vPvjhIx4tcGDYACQY20BMxgYi1AOBPJj8Q5ziUTAKRsEoGFkAAFNFWXivwczBAAAAAElFTkSuQmCC","orcid":"","institution":"Arbaminch College of Health sciences","correspondingAuthor":true,"prefix":"","firstName":"Dereje","middleName":"","lastName":"Dana","suffix":""},{"id":450169508,"identity":"446ec11a-15ae-423b-ad56-49ebeacba4ae","order_by":1,"name":"Mesfin Kote","email":"","orcid":"","institution":"Arba Minch University","correspondingAuthor":false,"prefix":"","firstName":"Mesfin","middleName":"","lastName":"Kote","suffix":""},{"id":450169509,"identity":"c7142e7c-fced-4d1c-9aa1-f2cef90bf729","order_by":2,"name":"Eshetu Zerihun","email":"","orcid":"","institution":"Arba Minch University","correspondingAuthor":false,"prefix":"","firstName":"Eshetu","middleName":"","lastName":"Zerihun","suffix":""},{"id":450169510,"identity":"2aa2c4d1-42de-4c63-9dbe-28704935d68b","order_by":3,"name":"Getahun Gedabo","email":"","orcid":"","institution":"Arbaminch College of Health sciences","correspondingAuthor":false,"prefix":"","firstName":"Getahun","middleName":"","lastName":"Gedabo","suffix":""},{"id":450169511,"identity":"9a520cdc-8a56-4145-8339-f3f42f1b0efc","order_by":4,"name":"Biruk Wogayehu","email":"","orcid":"","institution":"Arbaminch College of Health sciences","correspondingAuthor":false,"prefix":"","firstName":"Biruk","middleName":"","lastName":"Wogayehu","suffix":""}],"badges":[],"createdAt":"2025-01-28 15:23:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5919462/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5919462/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12879-025-11224-7","type":"published","date":"2025-07-01T15:58:10+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82067281,"identity":"27418049-4344-4cd1-be72-b012dafb1718","added_by":"auto","created_at":"2025-05-06 12:44:02","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":50212,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5919462/v1/df68d47de6d1fbce824c600b.jpg"},{"id":82065948,"identity":"5e06ec8d-f9db-4bcc-8b6c-a5b7ac66e673","added_by":"auto","created_at":"2025-05-06 12:36:02","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":12824,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5919462/v1/66295a521de885e35b90fd40.jpg"},{"id":82065949,"identity":"cb52c2ea-8d6e-4f8b-aea2-0d991124785a","added_by":"auto","created_at":"2025-05-06 12:36:02","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":10041,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5919462/v1/5a6beab2b633dfea30d0c065.jpg"},{"id":82067286,"identity":"31fb60cc-d612-4fc8-bfc7-aa0761c8be4f","added_by":"auto","created_at":"2025-05-06 12:44:02","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":11816,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5919462/v1/b71770124e214d869df6bd6c.jpg"},{"id":86179874,"identity":"44ea3d50-17b6-4afd-9ee3-509a8830959b","added_by":"auto","created_at":"2025-07-07 16:20:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1042031,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5919462/v1/4a40ad0e-2d73-4c75-a74b-0b5436c6a0ad.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Time to a Tuberculosis Treatment Cure and Its Predictors among Tuberculosis Patients at Public Health Facilities in Arbaminch Town, South Ethiopia: A Retrospective Cohort Study","fulltext":[{"header":"Background","content":"\u003cp\u003eTuberculosis is a chronic infectious disease caused by \u003cem\u003eMycobacterium tuberculosis\u003c/em\u003e that mostly affects the lungs [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Significant advancements have been made in the fight against tuberculosis (TB) across Africa, according to the 2023 Global TB. According to the WHO treatment guidelines, the essential anti-TB drugs are isoniazide, rifampicin, pyrazinamide, ethambutol, and streptomycin [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The first-line treatment for TB in Ethiopia is rifampicin (R), ethambutol (E), isoniazid (H), pyrazinamide (Z), and streptomycin (S). Drugs are available in fixed-dose combinations and are available as single drugs [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe treatment of TB has two phases: intensive (initial) and continuation. This phase consists of three or more drugs for the first 8 weeks for new cases and 12 weeks for retreated cases. During this phase, patients are given a combination of four first-line anti-TB drugs: isoniazid, rifampicin, pyrazinamide, and ethambutol. The continuation phase requires at least two drugs to be taken for 4\u0026ndash;6 months. In this phase, medications are often self-administered by the patient, and they must collect their drugs monthly from a healthcare facility [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the Global Tuberculosis Report of 2022 by the World Health Organization, 1.3\u0026nbsp;million people died from TB globally [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. A total of 10.6\u0026nbsp;million individuals worldwide are expected to have contracted tuberculosis in 2022, with the bulk of those cases occurring in the WHO Regions of Southeast Asia, Africa, and the Western Pacific. Significant TB (tuberculosis) obstacles were faced by the African area in 2022 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Africa, almost 2.5\u0026nbsp;million individuals are TB ill [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. According a systematic review and meta-analysis showed that the pooled cure rate was 64.5% (95% CI 55.1\u0026ndash;73.3%) which was obtained from 14 studies in Sub-Saharan Africa [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Among the 10,156 smear-positive PTB patients evaluated on DOTS in North Central Nigeria, 20.1% were cured at the end of treatment [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Another study in Nigeria reported treatment cure rates of 61.5% in patients under facility-based DOTS [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. A retrospective follow study conducted in Ghana revealed that the cure rate of TB patients was 30.7% [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn 2023, Ethiopia made significant progress in reducing the incidence of tuberculosis (TB) by approximately 34% since 2015, according to the 2023 Global TB Report by the World Health Organization (WHO). However, the country continues to have a high total incidence of TB 165 per 100,000 people [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Ethiopia was one of the seven countries that achieved the 2021 milestones of the WHO's End TB Strategy [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. A recent systematic review and meta-analysis of studies conducted in Ethiopia reported a pooled tuberculosis treatment cure rate of 33.9% (95% CI: 26.3\u0026ndash;41.5%) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Retrospective follow-up studies conducted in different regions of Ethiopia have reported variable cure rates: 85.5% in the Tigray region [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], 33.7% in Eastern Ethiopia [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], 27.5% in Southern Ethiopia [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], and 12.6% in Northwestern Ethiopia [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe majority of studies conducted in sub-Saharan Africa, including those from Ethiopia [\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11 CR12 CR13\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], have not assessed the time to tuberculosis treatment cure using survival analysis, limiting insights into the temporal dynamics of recovery. To reach global target of treatment success rate of at least 90% for all forms of TB by 2035 [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], evaluating time to TB treatment cure is essential for assessing the efficacy of treatment interventions and ensuring the best possible patient outcomes. Our findings are critical for reducing the impact of TB by identifying potential predictors that influence the time to TB treatment cure. Therefore, our study aimed to determine time to TB treatment cure and its predictors among TB patients in all public health facilities in Arbaminch Town for the period from January 2021 to December 2023.\u003c/p\u003e"},{"header":"Methods and materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Area and period\u003c/h2\u003e \u003cp\u003eArba Minch town is the capital town of the Gamo zone. It is located 505 kms from Addis Ababa (capital city of Ethiopia). The town is one of the lowlands in southern Ethiopia and has a hot climate with an average temperature of 29\u0026deg;C and annual mean rainfall of 900 mm. The town has 2 subdivisions: Secha and Sikela, each 5 kms apart, and the town has a total population of 125,411. There are four public health facilities in the town: Arbaminch General Hospital, Dilfana Primary Hospital, Secha Health Center and Woze Health Center. The facilities serve more than four million people in Arba Minch town and neighboring zones. All facilities provide TB treatment services. The study included TB registrations from January 1, 2021, to December 30, 2023.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy design and population\u003c/h3\u003e\n\u003cp\u003eA facility-based retrospective cohort study design was conducted among adult TB patients aged 18 years and older, who were registered in the TB logbook from January 2021 to December 30, 2023. The source population consisted of TB patients who initiated treatment at public health facilities. The study population included TB patients registered in the TB logbook from January 2021 to December 30, 2023, at Arbaminch General Hospital, Dilfana Primary Hospital, Secha Health Center and Woze Health Center.\u003c/p\u003e\n\u003ch3\u003eEligibility criteria\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eInclusion\u003c/strong\u003e \u003cp\u003eThis study included the records of all TB patients registered at Arbaminch General Hospital, Dilfana Primary Hospital, Secha Health Center and Woze Health Center from January 2021 to December 2023, who were bacteriologically positive using Gene Xpert.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eExclusion\u003c/strong\u003e \u003cp\u003ePatients were excluded if they had incomplete medical records for at least one variable, were transferred to or from other healthcare facilities, were children, pregnant women, individuals with multidrug-resistant tuberculosis (MDR-TB), or had extra-pulmonary tuberculosis.\u003c/p\u003e \u003c/p\u003e\n\u003ch3\u003eSample size determination\u003c/h3\u003e\n\u003cp\u003eThe sample size was determined via two population proportion formulas via the Epi info version 7 stat calc program by considering the following assumptions: 95% CI, power 80%, ratio of unexposed to exposed 1:1, and parameters: outcome in exposed (sex client female)\u0026thinsp;=\u0026thinsp;89.7%, outcome in unexposed (sex client male)\u0026thinsp;=\u0026thinsp;72.9% [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], and AOR\u0026thinsp;=\u0026thinsp;2.8. Accordingly, the calculated sample size for this study was 628 (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e-Sample size determination\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS.No\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePower\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSample size\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLoss to F/Up\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eFinal sample\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHIV stats\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e572\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e628\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eSampling technique\u003c/h3\u003e\n\u003cp\u003eFigure 1 shows sampling procedure to select patients registered in each facility\u0026rsquo;s TB logbook. TB patients were selected from the four health facilities using proportional allocation based on the number of patients registered in each facility\u0026rsquo;s TB logbook. Specifically, 268 patients were from Arbaminch General Hospital, 198 patients from Dilifana primary hospital, 85 patients from Secha Health Center, and 77 patients from Sikela Health Center. In this study, we employed a simple random sampling technique to recruit a predetermined sample size via the registration/card numbers of the enrolled clients. Computer-generated random numbers were utilized to select study participants' records from each consecutive year. From a total of 1097 TB patient records collected between January 1, 2021, and December 31, 2023, 628 samples were selected (Fig.\u0026nbsp;1). The necessary information was then extracted from these records, which were obtained from Arba Minch General Hospital, Dilfana Primary Hospital, Secha Health Center and Woze Health Center.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eVariables and measurement\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eDependent variable\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eTime to TB treatment cure\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStatus variable\u0026thinsp;=\u0026thinsp;1 if cured and 0\u0026thinsp;=\u0026thinsp;if not cured\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eIndependent variables\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eHistory of treatment: New, previous history\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePatient category: New case,, retreatment\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHIV co-infection: TB/HIV co-infected, without co-infection\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eBaseline characteristics and underlying illness, comorbidity, and adherence.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSocio-demographic factors: Age, sex\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAnthropometric factors: Age, height and BMI\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eOperational definition\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eTime to cure\u003c/b\u003e: The time from anti-TB treatment initiation to cure during anti-TB therapy [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eTB cure\u003c/b\u003e: A pulmonary TB patient with bacteriologically confirmed TB at the beginning of treatment who was smear- or culture-negative in the last month of treatment and had at least one previous occasion [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eTreatment completed\u003c/b\u003e: A patient who completed treatment but without evidence of failure of BUT with no record of sputum or culture results in the last month of treatment and on at least one previous occasion was negative, either because tests were not performed or because the results were unavailable [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eTreatment success\u003c/b\u003e: A sum of cured and completed treatment [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eCensored cases\u003c/b\u003e: All patients whose TB treatment outcomes were terminated except for a cure during anti-TB treatment were included [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eRetreatment cases\u003c/b\u003e: Have received 1 month or more of anti-TB drugs in the past [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eBaseline body weight\u003c/b\u003e: The weight of the patients at the time of anti-TB treatment initiation.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eData collection tool and procedure\u003c/h2\u003e \u003cp\u003eThe source of data is individual patient record documents, including register monitoring cards and patient folders. Data were collected via a structured checklist or questionnaire using Koobo tool. The checklist included information on socio-demographic characteristics (age and sex), clinical and treatment-related variables (including history of treatment\u0026mdash; new or previous history \u0026mdash; and TB/HIV co-infection status, weight, height, BMI), HIV status, and treatment outcomes (cured, treatment completed, treatment failure, default, died, or transferred out). Data collection forms and appropriate modifications concerning this study were made. This is prepared in English. Data were collected by six diploma-level health professionals trained in clinical nursing, under the supervision of two BSc-level health professionals qualified as health officers.\u003c/p\u003e \u003cp\u003eA one-day training session was provided to the data collectors by the principal investigator, covering the study objectives, participant selection procedures, confidentiality protocols, questionnaire content, data collection procedures, and data quality assurance measures. Each day following data collection, completed questionnaires were reviewed for completeness by the supervisor and the principal investigator, and feedback was provided to the data collectors the following day.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eData quality management\u003c/h2\u003e \u003cp\u003eData quality was assured by careful design of the data extraction formats, appropriate modifications, appropriate recruitment, and adequate training and follow-up for the data collectors and supervisors. The pretest was performed on 5% of the population (n\u0026thinsp;=\u0026thinsp;31) at Arba Minch General Hospital (n\u0026thinsp;=\u0026thinsp;23) and Arba Minch Dil Fana Primary Hospital (n\u0026thinsp;=\u0026thinsp;8). The principal investigator and supervisor provided intensive supervision during the entire period of data collection. The principal investigator reviewed a random sample of registration forms to confirm the reliability of the data before data collection, and the investigators also made random cross-checks for completeness, accuracy, and consistency at the end of each day, corrective discussion was undertaken with all the research team members. During the morning hours, remarks were made regarding the techniques that can be utilized to remove or limit errors and to take remedial steps. The data were checked for completeness and consistency.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eData processing and analysis\u003c/h2\u003e \u003cp\u003eAfter data collection, the data were downloaded from the Kobo tool in Excel format. Exported to STATA version 17 for analysis and data management, the data were then investigated to assess the extent of missing values, identify notable outliers, examine multicollinearity, evaluate normality, and determine the proportionality of hazards over time. Graphical and statistical methods such as the Kolmogorov\u0026ndash;Smirnov test were applied to check the normality of the data. The Cox regression model for its fitness to the data and its adequacy was checked by graphing residual plots such as the Cox-Snell residual.\u003c/p\u003e \u003cp\u003eA Kaplan\u0026ndash;Meier survival curve together with the log-rank test was fitted to test the survival time of patients receiving TB treatment. Variables significant at the \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;or equal to 0.25 level in the bivariate analysis, biological plausibility, and previous study were considered and included in the final Cox regression analysis to identify independent predictors of TB treatment cure. The crude hazard ratio, adjusted hazard ratio (adjusted hazard ratio), 95% CI, and \u003cem\u003eP\u003c/em\u003e value were used to assess the strength of the associations and their statistical significance. Covariates were checked for interaction effects. The data are presented in the text, tables, and figures.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eSocio-demographic and clinical characteristics\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the socio-demographic and clinical characteristics of participants. A total of 628 TB cards were reviewed. The mean age of the TB patients was 36.24 (\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;5.7) years. The study included a total of 628 tuberculosis (TB) patients. The majority of patients (73.89%) were aged between 25 and 64 years, followed by those aged 15 to 24 years (16.40%) and those aged 65 years or older (9.71%). The sex distribution revealed that more female patients (54.14%) than male patients (45.86%) were included in the study population. Most of the patients were treated at primary health facilities (57.32%) rather than secondary health facilities (42.68%). The average weight of the patients was 59.96 kg (\u0026plusmn;\u0026thinsp;10.9), and the average height was 1.65 meters (\u0026plusmn;\u0026thinsp;0.8), with varying body mass index (BMI) values. Most of the patients (78.03%) had a normal BMI, whereas 12.58% and 9.39% were overweight and underweight, respectively. The great majority of the patients (94.27%) were new cases of TB, and only 5.73% of the patients had received previous TB treatment. Comorbidities were rare; only 1.76% of the patients were HIV positive and the other 98.25% were HIV negative (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic and clinical characteristics of TB patients at a public health facility in Arbaminch town, South Ethiopia (n\u0026thinsp;=\u0026thinsp;628)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge of TB patients in years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e464\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGreater or equal to 65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e36.24 years (\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;5.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex of the TB patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e288\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFacility type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary health facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e268\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary health facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e360\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWight in kg (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e59.96 (\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;10.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight in meters (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e1.65(\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;0.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnderweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e490\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOver weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePatient category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNew case\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e592\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRe-treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHIV co-infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHIV positive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHIV negative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e617\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eTuberculosis treatment outcomes of patients\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e indicates tuberculosis treatment outcomes. The study results demonstrate a very high cure rate of 91.24%, indicating effective tuberculosis (TB) management and treatment within the study population. The low percentages of deaths (1.27%), defaulters (2.23%), and patients requiring retreatment highlight good adherence to treatment protocols and successful healthcare interventions. However, a transfer-out rate of 3.98%, although not excessively high, suggests that a small number of patients need to be managed in different facilities (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTuberculosis treatment outcomes of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eoutcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCured\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e573\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDefaulter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransfer out\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetreatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eSurvival analysis results\u003c/h2\u003e \u003cp\u003eThe median survival time was 162 (95% CI: 158, 164) days, and the multicollinearity of the covariates in this study was measured by the variance inflation factor (VIF), which was 1.21. The time to cure tuberculosis (TB) is influenced by several key factors, including the type of healthcare facility, the patient's sex, the HIV status, and the treatment history. Patients treated in secondary health centers had a greater hazard of cure than did those treated in primary health centers, with an adjusted hazard ratio (AHR) of 1.69 (95% CI: 1.4, 2.00). The hazard of cure was 70% lower for male patients than for female patients (AHR\u0026thinsp;=\u0026thinsp;0.3 (95% CI: 0.29, 0.433)). Compared with HIV-negative patients, patients without HIV had a greater hazard of cure but no statistically significant hazard of cure (AHR: 1.05; 95% CI: 0.4, 2.39).\u003c/p\u003e \u003cp\u003eThe hazard of cure was 44% lower for patients with a history of previous TB treatment than for new patients (AHR\u0026thinsp;=\u0026thinsp;0.56 (95% CI: 0.35, 0.96)). A one-unit increase in weight increases the hazard of cure by 2% (95% CI: 1.01, 1.03). Patients with a normal BMI had a slightly greater hazard ratio for being cured than underweight patients did. The adjusted hazard ratio (AHR) of 1.04 indicates that, after adjusting for other variables, the hazard of being cured for normal weight patients is 4% greater than that for underweight patients. These findings highlight the impact of healthcare facility type, sex, BMI, comorbidity status, and treatment history on TB patient cure (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSurvival status of TB patients at a public health facility in Arbaminch town, Southern Ethiopia (n\u0026thinsp;=\u0026thinsp;628)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eVariable (n\u0026thinsp;=\u0026thinsp;628)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eSurvival status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCHR(95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAHR(95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP- values\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCure N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCensored N(%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFacility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary health center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e256(42.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(18.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.69(0.5, 0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.69(1.4, 2.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary health center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e308(54.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52(81.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e274(48.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14(21.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e290(51.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50(78.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.4(0.39, 0.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.3(0.29,0.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHIV co-infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(7.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWithout HIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e558(98.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59(92.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.13(1.50, 2.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.05(0.4, 2.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePatient category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNew case\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e546(96.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46(71.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRe-treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18(3.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18(28.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.48(0.3, 0.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.56(0.35, 0.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50(8.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(14.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e438(77.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52(81.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.01(1.23 1.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.04(1.32 1.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76(13.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(4.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.37(1.02 1.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.37(1.02 1.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eTime to cure of patients\u003c/h2\u003e \u003cp\u003eOn the basis of the Kaplan‒Meier survival estimates, female patients are more likely to be cured than male patients (Fig.\u0026nbsp;2). The Cox proportional hazards regression plot in Fig.\u0026nbsp;3 presents the time to cure tuberculosis (TB) such that the survival probability begins at 1 (all patients ill) and decreases over time as patients are cured. In the beginning, after approximately 50 days, the survival curve is relatively flat, which means that few patients are cured at the beginning. There is a steep curve between 50 and 150 days, which means that there is a significant increase in the number of patients cured during this critical treatment phase. After 150 days, the curve continues to decline at a slower pace, which means that most patients have been cured, and by approximately 200 days, all patients have been cured. Thus, the plot demonstrated that the majority of patients achieved a cure between 50 and 150 days, with almost all patients cured by 200 days (Fig.\u0026nbsp;3).\u003c/p\u003e \u003cp\u003eThe Cox proportional hazards regression plot with the smoothed hazard function provides insight into the risk of being cured of tuberculosis (TB) over time. The Y-axis represents the smoothed hazard function, which indicates the instantaneous rate at which patients are cured, whereas the X-axis represents the analysis time in days. After 150 days, the hazard function increases sharply, indicating a significant increase in the rate at which patients are cured. This steep increase suggests that most patients achieve a cure during this period (Fig.\u0026nbsp;4).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to evaluate the time to cure status and predictors influencing the cure rate of tuberculosis (TB) patients admitted to public health facilities in Arba Minch town from 2021\u0026ndash;2023. The median survival time in this study was 162 days, which is comparable to that reported in a similar study conducted in Mezan, Southwest Ethiopia, which reported a survival range of 156\u0026ndash;180 days [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Differences in the study setting may account for the variations observed.\u003c/p\u003e \u003cp\u003eThe cure rate in our study was 91.24%, which exceeds the rates reported in studies from Nigeria (61.5%) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], Ghana (30.7%) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], and Sub-Saharan Africa overall (64.5%) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Similarly, our cure rate was higher than those reported in studies from the Tigray region (85.5%) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], Eastern Ethiopia (33.7%), Southern Ethiopia (27.5%) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], and Northwestern Ethiopia (19.2%) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. These discrepancies may be attributed to variations in study design, geographic location, availability of tuberculosis (TB) medications, and access to TB care services. Moreover, our cure rate surpassed the World Health Organization (WHO) recommended standard of 90%, indicating that TB care services in our study area meet and exceed international performance benchmarks [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study also indicated that the majority of cures occurred in secondary health facilities rather than primary health facilities. This observation can be attributed to Ethiopia's tiered healthcare system, which is structured into primary, secondary, and tertiary levels, each with distinct roles in delivering healthcare services. Primary health facilities, including health posts and centers, focus on preventive, promotive, and basic curative services and are designed to be accessible to rural populations [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In contrast, secondary health facilities provide more specialized care, including surgical procedures and inpatient care for serious illnesses, and typically cater to patients referred from primary facilities.\u003c/p\u003e \u003cp\u003eCompared with males, females exhibit better survival outcomes. A study conducted in Europe revealed that men are significantly more likely to die from TB than women are [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This disparity could be linked to the greater likelihood of men having comorbid conditions such as smoking-related illnesses or other chronic diseases that complicate TB treatment and worsen survival outcomes. Studies indicate higher on-treatment mortality rates for male patients due to these additional health challenges [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatients with a history of previous TB treatment had poorer survival outcomes than those who were receiving treatment for the first time. Research shows that previously treated patients face a significantly greater risk of adverse outcomes, including lower treatment success rates and higher rates of complications [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUnderweight patients account for a significant proportion of tuberculosis (TB) cases because several interrelated factors impair their immune response and increase susceptibility to the disease. Research indicates that individuals with a body mass index (BMI) less than 18.5 are at markedly greater risk for developing TB, as underweight status is associated with compromised immune function. For example, a study reported that the risk of TB incidence increased with increasing severity of underweight, with adjusted hazard ratios indicating that individuals with mild, moderate, and severe thinness had 1.98, 2.50, and 2.83 times greater risks of developing TB, respectively, than individuals with normal weight [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWeight has been shown to be significantly associated with treatment outcomes in tuberculosis (TB) patients, with higher weight correlating with improved cure rates. A consistent study conducted in Northwest Ethiopia revealed that patients who gained weight during TB treatment had better outcomes [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. This is because proper nutrition strengthens the immune system, which is crucial for fighting infections.\u003c/p\u003e \u003cp\u003eThese findings provide valuable insights into the factors influencing TB treatment outcomes in Arba Minch and underscore the importance of addressing specific patient needs and healthcare system structures to improve survival rates and overall treatment success.\u003c/p\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the study\u003c/h2\u003e \u003cp\u003eThe study's retrospective cohort design led to the exclusion of several important variables, such as socio-demographic and socioeconomic factors, including dietary intake, wealth status, educational level, and distance to healthcare facilities. Additionally, this study focused exclusively on pulmonary tuberculosis (TB), and therefore, the findings may not be generalizable to patients with extra pulmonary TB. Furthermore, bacteriologically positive patients were identified using the GeneXpert assay; however, culture results were not considered in this study.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, female sex, history of TB treatment, increased weight, and type of health facility were found to be independent predictors of a cure, and the median recovery time was 162. Therefore, working on these predictors to improve TB treatment cure is critical. This comprehensive analysis of TB patient characteristics is crucial for improving patient management and care continuity. Additionally, considering the observed sex differences, tailored strategies to address the specific needs of male patients may further enhance treatment outcomes. Further prospective cohort studies are also recommended to explore the underlying mechanisms influencing these predictors of time to TB cure.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAFB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAcid-fast bacilli\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAHR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdjusted hazard ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCHR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCrude hazard ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDOTs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDirectly observed therapies\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEPTB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eExtra pulmonary tuberculosis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePTB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePulmonary tuberculosis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTuberculosis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn ethical clearance letter was obtained from Arbaminch University's institutional review board (Protocol No.: DD23258). Prior to data collection, the administrations of Arba Minch General Hospital, Arba Minch Dil Fana Primary Hospital, Secha Health Center and Woze Health Center were informed about the study objectives and procedures. Permission for the study was obtained from the hospital administrations. Upon completion of data collection, the records were returned to the registry and stored on the designated shelves without disrupting the routine operations of the center. The data collection forms did not include any personally identifiable information, such as patient names, addresses, telephone numbers, or the names of the healthcare providers. Additionally, confidentiality was maintained by using anonymous tool and ensuring that all data were securely stored.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of the data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets of the study are available on reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors were involved in the conception of the study, design, data acquisition, data analysis and interpretation. The manuscript was also developed through active participation of all authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank our colleagues who gave useful advice on the completion of this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWHO. Global tuberculosis report 2024. Geneva: World Health Organization; 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrganization WH, Initiative ST. Treatment of tuberculosis: guidelines. World Health Organization; 2010.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBagcchi S. WHO's global tuberculosis report 2022. Lancet Microbe. 2023;4(1):e20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIzudi J, Semakula D, Sennono R, Tamwesigire IK, Bajunirwe F. 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BMC Infect Dis. 2013;13(1):297. 2013/07/01.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. The end TB strategy. Geneva: WHO2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGetie A, Alemnew B. Tuberculosis treatment outcomes and associated factors among patients treated at Woldia General Hospital in Northeast Ethiopia: an Institution-Based Cross-Sectional Study. Infect Drug Resist. 2020:3423\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDefinitions W. reporting framework for tuberculosis\u0026ndash;2013 revision. Geneva: World Health Organization; 2013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTerefe A, Gebrewold L. Modeling Time to Recovery of Adult Tuberculosis (Tb) Patients in Mizan-Tepi University Teaching Hospital, South-West Ethiopia. Mycobact Dis. 2018;8(258):2161\u0026ndash;10681000258.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCroke K. The origins of Ethiopia's primary health care expansion: the politics of state building and health system strengthening. Health Policy Plann. 2020;35(10):1318\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTiruneh BT, McLelland G, Plummer V. National Healthcare System Development of Ethiopia: A Systematic Narrative Review. Hosp Top. 2020 Apr-Jun;98(2):37\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePape S, Karki SJ, Heinsohn T, Brandes I, Dierks M-L, Lange B. Tuberculosis case fatality is higher in male than female patients in Europe: A systematic review and meta-analysis. Infection. 2024;52(5):1775\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaluku JB, Mukasa D, Bongomin F, Stadelmann A, Nuwagira E, Haller S, et al. Gender differences among patients with drug resistant tuberculosis and HIV co-infection in Uganda: a countrywide retrospective cohort study. BMC Infect Dis. 2021;21(1):1093.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNdambuki J, Nzomo J, Muregi L, Mutuku C, Makokha F, Nthusi J, et al. Comparison of first-line tuberculosis treatment outcomes between previously treated and new patients: a retrospective study in Machakos subcounty, Kenya. Int Health. 2021;13(3):272\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCho SH, Lee H, Kwon H, Shin DW, Joh H-K, Han K, et al. Association of underweight status with the risk of tuberculosis: a nationwide population-based cohort study. Sci Rep. 2022;12(1):16207.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSahile Z, Tezera R, Haile Mariam D, Collins J, Ali JH. Nutritional status and TB treatment outcomes in Addis Ababa, Ethiopia: An ambi-directional cohort study. PLoS ONE. 2021;16(3):e0247945.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWagnew F, Alene KA, Kelly M, Gray D. Impacts of body weight change on treatment outcomes in patients with multidrug-resistant tuberculosis in Northwest Ethiopia. Sci Rep. 2024;14(1):508.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Tuberculosis, TB treatment cure, time to TB treatment cure","lastPublishedDoi":"10.21203/rs.3.rs-5919462/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5919462/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: The WHO's 2022 Global Tuberculosis Report shows that TB causes 1.3 million deaths annually, including 167,000 TB-HIV confections. It affects 10.6 million people, mainly in Asia and Africa, 75% of whom are in the economically active age group of 15--54 years. Treatment interruptions hinder efforts to eliminate TB by 2030. According to a recent systematic review conducted using Ethiopian studies indicated that the pooled prevalence of TB treatment cure rate was 33.9%. There is a lack of evidence on time to TB treatment cure in Ethiopia using survival analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: This study aimed to determine the time to TB treatment cure and its predictors among tuberculosis patients from January 2021 to December 2023 at public health facilities in Arba Minch town. South Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e An institution-based retrospective cohort study was conducted among 628 selected TB patients who were admitted to the TB care unit at Arba Minch General Hospital, Dilfana Primary Hospital, and both health centers from 2021 to 2023. A Kaplan Meier survival curve was fitted to test the survival time. The Cox proportional hazards model was used to identify predictors with TB treatment cure. Significance was considered at a \u003cem\u003ep\u003c/em\u003evalue ≤ 0.05 with an adjusted hazard ratio (HR) 95% CI in the multivariate analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Out of the 628 patients whose records were analyzed, the median time to cure was 162 days. The significant predictors of time to TB cure included being male (AHR 0.3, 95% CI: 0.35–0.95), history of TB treatment (AHR 0.56, 95% CI: 0.35–0.95), and normal BMI (AHR 1.04, 95% CI: 1.32–1.49).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: Female sex, a history of TB treatment, increased weight, and health facility type were found to be independent predictors of time to cure. Therefore, working on these predicators to improve TB treatment is critical.\u003c/p\u003e","manuscriptTitle":"Time to a Tuberculosis Treatment Cure and Its Predictors among Tuberculosis Patients at Public Health Facilities in Arbaminch Town, South Ethiopia: A Retrospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-06 12:35:57","doi":"10.21203/rs.3.rs-5919462/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-12T09:26:34+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-10T17:18:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-05T15:41:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"269143126524429143176468583149540720999","date":"2025-05-05T14:56:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"261683725790197020433124695299669335941","date":"2025-04-30T11:07:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-30T06:58:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-30T00:15:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2025-04-28T14:56:13+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6efb6fc5-1cb1-421e-b917-868cb66804bf","owner":[],"postedDate":"May 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-07T16:11:55+00:00","versionOfRecord":{"articleIdentity":"rs-5919462","link":"https://doi.org/10.1186/s12879-025-11224-7","journal":{"identity":"bmc-infectious-diseases","isVorOnly":false,"title":"BMC Infectious Diseases"},"publishedOn":"2025-07-01 15:58:10","publishedOnDateReadable":"July 1st, 2025"},"versionCreatedAt":"2025-05-06 12:35:57","video":"","vorDoi":"10.1186/s12879-025-11224-7","vorDoiUrl":"https://doi.org/10.1186/s12879-025-11224-7","workflowStages":[]},"version":"v1","identity":"rs-5919462","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5919462","identity":"rs-5919462","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}