Nationwide assessment of tuberculosis treatment outcomes and their determinants in Indonesia: A retrospective cohort study of over one million cases (2020-2022)

Indonesia remains one of the highest tuberculosis (TB) burden countries globally. Despite national efforts to expand TB care, disparities in treatment outcomes persist across regions and population subgroups. This study aimed to evaluate TB treatment outcomes and identify their determinants using national surveillance data from 2020 to 2022.

We conducted a retrospective cohort study using data from the national SITB TB registry. A total of 1,022,351 drug-sensitive TB patients with complete treatment outcome records were included. Multivariable logistic regression models were used to identify factors associated with treatment success. ROC curves were generated to evaluate model performance across Western, Central, and Eastern Indonesia. Stratified analyses were conducted by year and region.

The overall treatment success rate was 92.1 %. Female sex (aOR: 1.20; 95 % CI: 1.19–1.22), younger age, and new treatment status were associated with higher odds of success, while HIV positivity (aOR: 0.22; 95 % CI: 0.21–0.23), diabetes (aOR: 0.79; 95 % CI: 0.77–0.81), and retreatment cases predicted poorer outcomes. Regional analysis showed that treatment success was highest in Western Indonesia (93.2 %), followed by Central (91.5 %) and Eastern Indonesia (89.8 %). Predictive model performance was modest, with AUCs ranging from 0.59 in Eastern Indonesia (2021) to 0.65 in Central Indonesia (2020).

Although Indonesia has achieved high national TB treatment success rates, disparities remain across regions and patient subgroups. Tailored strategies are needed to improve outcomes in Eastern Indonesia and among high-risk populations. Strengthening integrated, region-specific TB care is critical to achieving national TB elimination targets.