Rates and Risk Factors for On-Treatment Mortality Among a Cohort of Adults Treated for Drug-Sensitive Tuberculosis: Analysis of Data From the Adherence Support Coalition to End Tuberculosis Consortium in Five Countries

Background Tuberculosis remains a leading cause of death globally, particularly in countries with high tuberculosis and HIV burdens. Disruptions caused by the COVID-19 pandemic may have further impacted tuberculosis outcomes. This study examines on-treatment mortality and associated risk factors in five countries. Method We conducted a secondary analysis of data from ASCENT cluster-randomised trials of digital adherence tools for improved adherence involving 23,799 adults with drug-sensitive tuberculosis in South Africa, Tanzania, Ethiopia, the Philippines, and Ukraine. Analyses were conducted separately by country. Mortality rates were measured from treatment initiation to the earliest of 6 months, death, or loss to follow-up. Cox regression models (with random effects or robust standard errors for clustering) assessed the associations between mortality and HIV status, ART use, tuberculosis diagnosis type, and calendar periods (COVID-19 pandemic and conflict in Ukraine). Results Mortality rates ranged from 7.6 (Ethiopia) to 23.2 (Tanzania) and 23.3 (Ukraine) per 100 person-years. Higher mortality was associated with: older age in all countries (age Conclusion Our findings suggest variability in tuberculosis mortality across settings, influenced by HIV/ART and diagnosis type. The high mortality rates across countries may reflect underlying causes or potential misdiagnoses. Further investigation into these factors may be needed to improve tuberculosis outcomes globally.