A94-06 Alcohol Use Disorder and Adverse Tuberculosis Treatment Outcomes Among Adults With Pulmonary Tuberculosis in India: A Dose-Response Analysis Using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) Scale

Abstract Rationale Alcohol Use Disorder (AUD) is a major risk factor for poor tuberculosis (TB) treatment outcomes. Prior studies using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) have shown positive associations between AUD and adverse TB outcomes; however, a dose-response relationship between increasing alcohol consumption and TB outcomes is underexplored in high-burden settings. We evaluated categorical and continuous AUDIT-C measures to quantify the association between alcohol use severity and TB outcomes using data from five Indian cohorts conducted between 2013-2025 Methods We analyzed data from 3,421 adults with PTB. Alcohol exposure was assessed at baseline using the 3-item AUDIT-C questionnaire (score 0-12). Exposure was modeled categorically (AUDIT-C > 4 for men, > 3 for women) and continuously (per 1-point increase). Multivariable logistic regression models estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for overall and individual adverse outcomes: death, loss to follow-up [LTFU], failure, and recurrence versus cure. Models adjusted for age, sex, schooling, BMI, smoking, HIV status, anemia, and diabetes. Results Participants with AUD were predominantly male (93% vs 61%) and older (median 45 vs 38 years; p < 0.001) than those without AUD. They also had lower BMI, higher rates of smoking, and a greater proportion experienced adverse treatment outcomes (34% vs 22%; p < 0.001). High-risk alcohol use was associated with 1.55-fold higher odds of composite adverse treatment outcome (95% CI 1.27-1.88, p < 0.001), with stronger effects among men (aOR 1.61 [1.30-1.98]) and no significant association among women (aOR 1.02 [0.46-2.04]).By individual outcome, AUD predicted treatment failure (aOR 2.00 [1.35-2.95]), recurrence (aOR 2.04 [1.20-3.43]), LTFU (aOR 1.42 [1.11-1.81]), and death (aOR 1.52 [0.90-2.56]). When modeled continuously, each 1-point increase in AUDIT-C score increased odds of composite adverse outcome by 5.9% overall (aOR 1.06 [1.03-1.09]) and 6.5% among men (aOR 1.07 [1.03-1.10]). The continuous score also predicted treatment failure (aOR 1.08 [1.03-1.14]), recurrence (aOR 1.10 [1.03-1.18]), LFTU (aOR 1.05 [1.01-1.09]), and death (aOR 1.05 [0.98-1.13] Conclusions AUD was strongly associated with adverse TB outcomes, particularly among men. Even modest increases in AUDIT-C score were linked with higher risks of treatment failure, recurrence, and loss to follow-up. Integrating routine alcohol screening and brief interventions into TB programs could substantially improve treatment completion and reduce recurrence in high-burden settings. This abstract is funded by: The Government of India’s Department of Biotechnology, the US National Institutes of Health’s National Institute of Allergy and Infectious Diseases Office of AIDS Research and distributed in part by Civilian Research and Development Foundation Global.