Gender Differences in Tuberculosis Treatment Outcomes

Background Tuberculosis (TB) remains the leading cause of death from a single infectious agent worldwide. Although TB incidence is consistently higher among men, it remains unclear whether gender disparities extend to TB treatment outcomes. This systematic review and meta-analysis aimed to evaluate the effect of biological sex on TB treatment outcomes, including cure, treatment completion, default, relapse, treatment failure, lost to follow-up, transferred, and death. Methods We searched PubMed, Embase, and the Cochrane Library for studies published between January 1, 2004, and March 26, 2024. Eligible studies were randomized controlled trials or nonrandomized studies assessing gender differences in TB treatment outcomes. Results Eleven cohort studies involving 16,455 participants from Africa, Asia, and South America met the inclusion criteria. No significant gender differences were found for cure, treatment completion, default, relapse, or treatment failure. However, women were significantly less likely than men to be lost to follow-up (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.39–0.7), to be transferred during treatment (OR, 0.66; 95% CI, 0.48–0.92), or to die (OR, 0.76; 95% CI, 0.59–0.97). All outcomes were rated as very low in certainty due to methodological limitations and uncontrolled confounding. Conclusions Although most TB treatment outcomes did not differ by gender, women had lower risks of treatment interruption and mortality. These findings highlight the need for gender-sensitive TB programs, particularly to improve treatment engagement and survival among men.