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Peer-reviewedCC BY 4.0PLOS Global Public Health

Factors associated with unsuccessful treatment outcomes among drug-resistant tuberculosis patients in Loreto, Peru, 2015–2023: A retrospective cohort study

  • Evelyn Genthell Cordova-Pisco1
  • Tery Vasquez-Hassinger2
  • Estela Huamán-Angeles3
  • Karine Zevallos4
  • George Obregon5
5 affiliations
  1. 1Laboratorio de Referencia Regional de Loreto, Gerencia Regional de Salud Loreto, Iquitos, Loreto, Perú
  2. 2Unidad de Investigación, Hospital Regional de Loreto, Iquitos, Loreto, Perú
  3. 3Universidad Científica del Sur, Lima, Perú
  4. 4Centro Nacional de Salud Pública, Instituto Nacional de Salud, Lima, Perú
  5. 5Facultad de Medicina Humana, Universidad Nacional de la Amazonía Peruana, Iquitos, Loreto, Perú
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Abstract

In Loreto, Peru, unsuccessful treatment outcomes among patients with drug-resistant tuberculosis (DR-TB) remain high, underscoring the need to identify associated factors in this Amazonian region. This retrospective cohort study included 417 DR-TB cases registered in the national TB system in Loreto between 2015 and 2023. Loss to follow-up, death, and treatment failure were combined into a single composite outcome variable defined as unsuccessful treatment outcome. Bivariate and multivariable logistic regression analyses were performed to estimate associations between sociodemographic, clinical, and programmatic factors and this outcome. Among the 417 cases analyzed, 49.5% had unsuccessful treatment outcomes: 34.1% due to loss to follow-up, 3.6% due to treatment failure, and 11.8% due to death. Loss to follow-up was the main driver of unsuccessful outcomes, suggesting important gaps in continuity of care and adherence support within the regional health system. In bivariate analyses, unsuccessful outcomes were associated with age 18–30 years (OR: 3.7; 95% CI: 1.6–8.5; p = 0.002), TB-HIV coinfection (OR: 2.4; 95% CI: 1.2–4.6; p = 0.012), previous treatment after loss to follow-up (OR: 2.9; 95% CI: 1.6–5.2; p < 0.001), high bacillary load (+++) (OR: 1.9; 95% CI: 1.0–3.5; p = 0.041), alcoholism (OR: 4.6; 95% CI: 1.5–14.1; p = 0.006), and drug addiction (OR: 7.0; 95% CI: 2.0–24.2; p = 0.002). In the multivariable analysis, alcoholism remained independently associated with unsuccessful outcomes (aOR: 4.0; 95% CI: 1.1–14.2; p = 0.029), while individualized treatment was associated with lower odds of unsuccessful outcomes (aOR: 0.4; 95% CI: 0.1–0.9; p = 0.023). Unsuccessful treatment outcomes among DR-TB patients in Loreto were mainly driven by loss to follow-up, highlighting persistent gaps in treatment continuity and adherence support. Programmatic priorities should include decentralized access to drug-susceptibility testing, community-based adherence strategies, and integrated screening and management of alcohol use within DR-TB care.

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Cite

BibTeXRIS
BibTeX
@article{cordovapisco2026factors,
  title = {{Factors associated with unsuccessful treatment outcomes among drug-resistant tuberculosis patients in Loreto, Peru, 2015–2023: A retrospective cohort study}},
  author = {Evelyn Genthell Cordova-Pisco and Tery Vasquez-Hassinger and Estela Huamán-Angeles and Karine Zevallos and George Obregon},
  journal = {PLOS Global Public Health},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pgph.0007229},
  url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007229},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Factors associated with unsuccessful treatment outcomes among drug-resistant tuberculosis patients in Loreto, Peru, 2015–2023: A retrospective cohort study
AU  - Evelyn Genthell Cordova-Pisco
AU  - Tery Vasquez-Hassinger
AU  - Estela Huamán-Angeles
AU  - Karine Zevallos
AU  - George Obregon
PY  - 2026
DA  - 2026/09/09
JO  - PLOS Global Public Health
DO  - 10.1371/journal.pgph.0007229
UR  - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007229
AB  - In Loreto, Peru, unsuccessful treatment outcomes among patients with drug-resistant tuberculosis (DR-TB) remain high, underscoring the need to identify associated factors in this Amazonian region. This retrospective cohort study included 417 DR-TB cases registered in the national TB system in Loreto between 2015 and 2023. Loss to follow-up, death, and treatment failure were combined into a single composite outcome variable defined as unsuccessful treatment outcome. Bivariate and multivariable logistic regression analyses were performed to estimate associations between sociodemographic, clinical, and programmatic factors and this outcome. Among the 417 cases analyzed, 49.5% had unsuccessful treatment outcomes: 34.1% due to loss to follow-up, 3.6% due to treatment failure, and 11.8% due to death. Loss to follow-up was the main driver of unsuccessful outcomes, suggesting important gaps in continuity of care and adherence support within the regional health system. In bivariate analyses, unsuccessful outcomes were associated with age 18–30 years (OR: 3.7; 95% CI: 1.6–8.5; p = 0.002), TB-HIV coinfection (OR: 2.4; 95% CI: 1.2–4.6; p = 0.012), previous treatment after loss to follow-up (OR: 2.9; 95% CI: 1.6–5.2; p < 0.001), high bacillary load (+++) (OR: 1.9; 95% CI: 1.0–3.5; p = 0.041), alcoholism (OR: 4.6; 95% CI: 1.5–14.1; p = 0.006), and drug addiction (OR: 7.0; 95% CI: 2.0–24.2; p = 0.002). In the multivariable analysis, alcoholism remained independently associated with unsuccessful outcomes (aOR: 4.0; 95% CI: 1.1–14.2; p = 0.029), while individualized treatment was associated with lower odds of unsuccessful outcomes (aOR: 0.4; 95% CI: 0.1–0.9; p = 0.023). Unsuccessful treatment outcomes among DR-TB patients in Loreto were mainly driven by loss to follow-up, highlighting persistent gaps in treatment continuity and adherence support. Programmatic priorities should include decentralized access to drug-susceptibility testing, community-based adherence strategies, and integrated screening and management of alcohol use within DR-TB care.
SN  - 2767-3375
ER  -