Treatment Outcomes of Tuberculosis in the Eastern Cape: Clinical and Socio-Demographic Predictors from Two Rural Clinics

<b>Background</b>: Tuberculosis (TB) remains a leading cause of morbidity and mortality, with South Africa among the highest-burden countries. The Eastern Cape is particularly affected due to poverty, HIV co-infection, and weak health systems. Understanding treatment outcomes and their determinants is required to achieve the WHO End TB Strategy targets. The objective of this study was to examine treatment outcomes for tuberculosis (TB) in both rural and urban clinics within the Eastern Cape Province. We aimed to identify the socio-demographic, clinical, and geographic factors that influence treatment success or failure. We included simple geographic visualisations comparing treatment outcomes between the two participating clinics to inform the development of targeted interventions aimed at enhancing TB control efforts. <b>Methods</b>: A retrospective cohort study of 385 TB patients treated at two public clinics in the Eastern Cape (2020-2024) was conducted. Socio-demographic, clinical, and geographical data were extracted from records. Outcomes were classified using WHO and South African National TB Programme guidelines. Logistic regression identified predictors of success, and spatial analysis mapped treatment outcomes. <b>Results</b>: The mean patient age was 40.6 years; 69.1% were HIV-positive, and 89.9% had pulmonary TB. The overall treatment success rate was 63.8%, below the WHO target of ≥85%. Pulmonary TB was independently associated with greater odds of success (aOR = 2.86, 95% CI: 1.23-6.65), while older age predicted poorer outcomes (aOR = 0.98, 95% CI: 0.963-0.998). HIV status and socioeconomic variables were not independently associated after adjustment, although poverty and unemployment were widespread. Spatial mapping showed clustering of poor outcomes in specific clinics, highlighting geographic and health system disparities. <b>Conclusions</b>: TB treatment outcomes in the Eastern Cape remain unsatisfactory. Older patients and those with extrapulmonary TB face higher risks of unfavourable outcomes, underscoring the need for closer monitoring and adherence support. Integrated TB/HIV care, social protection, and geographically targeted interventions are essential to strengthen health systems and reduce inequalities.