Magnitude and Determinants of Unsuccessful Tuberculosis Treatment Outcomes in Ethiopia: A Systematic Review and Meta-Analysis

Objective: Unsuccessful treatment outcomes of tuberculosis (TB), including treatment failure, death, and loss to follow-up, pose significant challenges to TB control programs. This systematic review and meta-analysis aimed to assess the magnitude and determinants of unsuccessful TB treatment outcomes in Ethiopia.Material and Methods: A comprehensive literature searches were conducted using databases such as PubMed, Scopus, and Google Scholar. Observational studies published between 2000 and 2024 that reported on TB treatment outcomes in Ethiopia were included. The pooled magnitude of unsuccessful TB treatment outcomes was estimated using a random-effects model. Subgroup analysis, and meta-regression, and publication bias assessments were also conducted in order to explore potential sources of heterogeneity. Results: The overall pooled magnitude of unsuccessful TB treatment outcomes in Ethiopia was 17% (95% confidence interval (CI): 15%-20%). Significant heterogeneity was observed between studies (I²=98.49%, p-value<0.01). Subgroup analysis revealed that unsuccessful outcomes were higher among patients with multidrug-resistant TB (31.7%) and those co-infected with Human Immunodeficiency Virus (HIV) (24.5%). Older age >45 years (HR: 1.82; 95% CI: 1.25-2.65) , HIV co-infection (HR: 2.10; 95% CI: 1.23-3.58), and retreatment (HR: 1.67; 95% CI: 1.13-2.47) were significant predictors of unsuccessful outcomes. Conclusion: Unsuccessful treatment outcome in Ethiopia is high. Multi-drug resistance TB and HIV co-infection had significant impact on TB treatment outcome. Therefore, the findings underscore the need for targeted interventions that address the key determinants of unsuccessful TB treatment outcomes in Ethiopia, particularly among high-risk populations such as multidrug-resistant TB (MDR-TB) patients and those co-infected with HIV.