Trends and determinants of tuberculosis treatment outcomes among patients at Hargeisa tuberculosis hospital, Somaliland (2019–2024): a multi-year retrospective study

BACKGROUND: Tuberculosis (TB) remains a major public health concern in Somaliland, and evidence on multi-year treatment outcomes is limited. This study assessed temporal trends and factors associated with TB treatment outcomes among patients managed at Hargeisa TB Hospital, Somaliland. METHODS: We conducted a register-based retrospective cohort study using routinely collected data from the Hargeisa TB Hospital treatment registers for patients initiating anti-TB treatment from 2019 to 2024. TB treatment outcomes were dichotomised as successful (cured or treatment completed) versus unsuccessful (death, loss to follow-up, treatment failure). Descriptive analyses were performed to present patient characteristics, while bivariate and multivariate logistic regression models were used to identify variables linked to treatment success. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated, and a p-value of less than 0.05 was considered statistically significant. RESULTS: Across the six-year period, treatment success rates remained above 85%. Significant predictors of treatment outcomes varied by year. Between 2020 and 2024, age consistently predicted outcomes, with patients aged ≥ 55 years significantly less likely to achieve successful treatment (AOR range: 0.24-0.44). HIV-negative patients had up to fourfold higher odds of treatment success (AOR = 4.30; 95% CI: 1.76-10.49; p = 0.001). CONCLUSION: TB treatment success consistently met or exceeded the World Health Organization benchmark of ≥ 85% across all study years. However, older age and TB/HIV co-infection remained associated with reduced treatment success even after stratification by TB type. These findings highlight the need to strengthen TB/HIV service integration and to provide enhanced clinical management and adherence support for older patients.