Risk factors associated with sputum smear and culture non-conversion following intensive phase treatment in pulmonary tuberculosis patients: a systematic review and meta-analysis

<bold>Introduction:</bold> Failure of sputum smear conversion after two months of intensive phase treatment has been associated with a higher rate of treatment failure in pulmonary tuberculosis patients. This study aimed to be the first meta-analysis to explore various demographic and clinical factors attributable to sputum smear non-conversion following the intensive phase of treatment in patients with pulmonary tuberculosis. <bold>Methods:</bold> Electronic databases were searched from inception until November 2023 under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled odds ratios (OR) were calculated using a random effects model with a 95% confidence interval. The I² index was used to assess heterogeneity among studies. Statistical analysis was performed using Review Manager 5.4. <bold>Results:</bold> A total of 28 studies comprising 35,177 patients met the inclusion criteria and were included in the final analysis. High pre-treatment smear grade (OR = 2.20, 95% Cl: 1.75-2.76), diabetes, (OR = 2.09, 95% Cl: 1.03-4.25), and smoking (OR = 1.74, 95% Cl: 1.40-2.17) were risk factors significantly associated with sputum smear non-conversion. High pre-treatment culture grade (OR = 4.62, 95% CI: 3.02-7.06), diabetes, (OR = 2.13, 95% Cl: 1.24-3.64), and male gender (OR = 2.02, 95% Cl: 1.45-2.83) were risk factors significantly attributed to sputum culture non-conversion. <bold>Conclusion:</bold> High pre-treatment smear and culture grade, diabetes, smoking, and male gender were factors significantly associated with sputum smear and culture non-conversion following intensive phase treatment for pulmonary tuberculosis.