Factors associated with tuberculosis treatment outcome under directly observed treatment short-course in Hulu Langat district, Selangor, Malaysia.

INTRODUCTION: Tuberculosis (TB) is a significant public health concern despite being a preventable and treatable infectious disease, as indicated by the rising incidence and mortality rates. This study aims to compare treatment outcomes by different Directly Observed Treatment, Short-Course (DOTS) supervisors and to identify significant factors associated with Tuberculosis treatment outcomes under DOTS in the Hulu Langat district. MATERIALS AND METHODS: A retrospective cohort study was conducted using registry-based data from the National Tuberculosis Registry (NTBR) between 2019 and 2023. Smear-positive PTB patients' sociodemographic, clinical and DOTS supervisor factors were extracted and analysed. Logistic regression was used to determine the significant factors associated with unsuccessful treatment outcomes. The data were analysed using SPSS version 29. RESULTS: Out of 5225 cases of Tuberculosis during the five years (2019-2023), 2548 cases met the inclusion criteria and were added to the analysis. The treatment success rate among Tuberculosis patients who enrolled in DOTS in the Hulu Langat district was 74.5%, comprising 70.8% who were cured and 3.6% who completed treatment. In contrast, 25.5% had unsuccessful treatment outcomes; 12.7% of patients died, followed by defaulters (8%), not evaluated or transferred out (2.6%), and treatment failure (2.3%). Compared to patients supervised by other DOTS supervisors, those supervised by family members had a significantly lower risk of unsuccessful treatment outcomes (AOR 0.34, 95% CI: 0.177-0.660, p=0.001). Besides that, significant factors associated with unsuccessful treatment outcomes include adult age (19-59 years) with an AOR of 3.60 (95% CI: 1.518-8.533, p=0.004), elderly age (≥60 years) with an AOR of 5.56 (95% CI 2.297-13.438, p<0.001), male gender (AOR 1.48, 95% CI: 1.183-1.838, p<0.001), foreigners (AOR 1.92, 95% CI: 2.366-3.687, p<0.001), rural residence (AOR 1.6, 95% CI: 1.090-2.349, p=0.016), HIV-positive (AOR 2.33, 95% CI: 1.508-3.586, p<0.001), moderate changes CXR findings (AOR 2.72, 95% CI: 1.245-5.945, p=0.012) and faradvanced CXR findings (AOR 5.30, 95% CI: 2.290-12.268, p<0.001). In contrast, the study found a significant decrease in the risk of unsuccessful treatment outcomes among Chinese ethnicity (AOR 0.74, 95% CI: 0.695-1.196, p=0.044) and tertiary education (AOR 0.55, 95% CI: 0.334-0.914, p=0.021). CONCLUSION: This study challenges the traditional focus on healthcare worker DOTS by highlighting the effectiveness of family-supervised DOTS in improving TB treatment outcomes. The findings underscore the potential for family- DOTS to be scaled up as a complementary strategy within the national TB programme. Thus, the study recommends that the Ministry of Health adopt a risk-stratified framework based on sociodemographic and clinical factors to guide the assignment of DOTS supervisors, ensuring each patient receives the most suitable type of supervision throughout their TB treatment. Tailored TB control strategies should also expand risk stratification beyond existing MOH highrisk groups to include males, the elderly, foreign nationals, rural residents, and those with abnormal radiological findings, with strengthened screening and supervision to improve treatment outcomes.