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Predictors of Treatment Outcomes Among HIV-Positive Patients with Drug-Resistant Tuberculosis in Rural Eastern Cape,

Thembile Zini¹, Urgent Tsuro², Lindiwe Modest Faye²

¹School of Public Health, Faculty of Medicine and Health Sciences, Walter Sisulu University, Private Bag X1, Mthatha 5100, South Africa.

International Journal of Environmental Research and Public Health

|May 4, 2026

Abstract

Background:

Drug-resistant tuberculosis (DR-TB) remains a major public health challenge in South Africa, particularly in rural settings with high HIV co-infection rates. Understanding predictors of treatment response among people living with HIV is essential for improving clinical management and programmatic outcomes. This study aimed to identify socio-demographic and clinical predictors of treatment outcomes among HIV-positive individuals diagnosed with multidrug-resistant (MDR) and extensively drug-resistant tuberculosis (XDR-TB) in rural Eastern Cape Province, South Africa.

Methods:

A retrospective cohort study was conducted using routinely collected clinical records of DR-TB patients initiated on treatment between January 2020 and December 2024 at two public healthcare facilities. A total of 239 patients with complete treatment outcome data were included. Treatment outcomes were classified as favourable (cured or treatment completed) or unfavourable (death, treatment failure, or loss to follow-up). Descriptive statistics were used to summarise patient characteristics, while univariate and multivariable logistic regression analyses were performed to identify factors associated with treatment outcomes.

Results:

Most participants were aged ≤ 39 years (58%), male (60%), unemployed (90%), and without income (80%). MDR-TB accounted for 40% of cases, rifampicin-resistant-TB (RR-TB) for 53%, and XDR-TB for 7.1%. Multivariable analysis showed that XDR-TB was the strongest independent predictor of unfavourable treatment outcome (AOR = 0.18; 95% CI: 0.06-0.58; p = 0.004). Income status was also significantly associated with outcome, with participants reporting some incomes having lower odds of favourable outcomes (AOR = 0.46; 95% CI: 0.23-0.92; p = 0.036). The model demonstrated modest predictive performance (AUC = 0.67).

Conclusions:

These findings highlight the dominant influence of resistance phenotype, particularly XDR-TB, on treatment prognosis among HIV-positive DR-TB patients in rural Eastern Cape. Integrating early resistance profiling, intensified clinical management of XDR-TB, and socioeconomic support mechanisms may improve treatment outcomes in high-burden rural settings.

Keywords:

Eastern Cape HIV co-infection MDR-TB XDR-TB drug-resistant tuberculosis logistic regression predictors public health rural health treatment outcomes

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