{"doi":"10.1093/cid/ciaf714","title":"Hidden in Success: Gendered Patterns of Suboptimal Care Engagement Among Tuberculosis Patients Who “Successfully” Completed Treatment in South Africa","abstract":"BACKGROUND: Timeously completing tuberculosis (TB) treatment is a key to optimal health outcomes. Suboptimal treatment refill patterns, even among those categorized as \"treatment success,\" may portend unfavorable outcomes. METHODS: Using patient-level medication refill data, latent-class mixed modeling was used to identify longitudinal trajectories of care engagement among TB patients achieving programmatic treatment success. Logistic regression was conducted to investigate participant-level characteristics associated with trajectory class membership. RESULTS: Among 548 participants, we identified 3 trajectories: Class 1 (consistent engagement; 84.1%), Class 2 (suboptimal engagement after 2 months; 7.7%), and Class 3 (suboptimal engagement from initiation; 8.2%). At treatment completion, Classes 1-3 accumulated 9.7 (95% confidence interval [CI]: 7.4-11.8), 68.4 (60.4-76.9), and 55.5 (48.1-62.7) missed refill days, respectively. In gender-stratified models, men exhibited all 3 trajectories (83.1%, 7.4%, and 9.5%, respectively), and accumulated 10.6 (7.8-13.3), 61.0 (50.2-71.3), and 62.31 (53.14-71.72) missed refill days, respectively. Women exhibited only Classes 1 and 3 (89.5% and 10.5%, respectively) and accumulated 12.1 (7.8-16.5) and 46.9 (33.3-61.6) missed refill days, respectively. Among men, prior TB (Class 2: adjusted odds ratio [aOR] 7.44, 2.79-19.8; Class 3: aOR 2.78, 1.07-7.25) and human immunodeficiency virus-negative status (Class 3: aOR 2.72, 1.13-6.54) were associated with suboptimal trajectories. Among women, prior TB was associated with suboptimal engagement (aOR 5.22, 1.11-24.44). CONCLUSIONS: Programmatic \"treatment success\" obscured heterogeneity in treatment refill patterns. Patient-centered counseling and gender-responsive interventions are needed to address treatment refill behaviors. Shorter regimens alone may not resolve suboptimal engagement, highlighting the need for flexible treatment strategies.","journal":"Clinical Infectious Diseases","year":2025,"id":549582,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9508,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1443784,"name":"Eke Arua","orcid":"0009-0007-0401-8004","position":1,"is_corresponding":false},{"id":505226,"name":"Lindsey de Vos","orcid":"0000-0001-5804-7651","position":2,"is_corresponding":false},{"id":1332176,"name":"Kuhle Fiphaza","orcid":null,"position":3,"is_corresponding":false},{"id":704760,"name":"Dana Bezuidenhout","orcid":"0000-0002-9492-943X","position":4,"is_corresponding":false},{"id":664367,"name":"Nondumiso Ngcelwane","orcid":null,"position":5,"is_corresponding":false},{"id":516266,"name":"Salome Charalambous","orcid":"0000-0001-7143-1009","position":6,"is_corresponding":false},{"id":1443785,"name":"Joseph Daniels","orcid":"0009-0000-4607-9568","position":7,"is_corresponding":false},{"id":326537,"name":"Andrew Medina‐Marino","orcid":"0000-0002-0095-4141","position":0,"is_corresponding":true}],"reference_count":30,"raw_metadata":null,"created_at":"2026-07-19T02:54:07.823422Z","pmid":"41417651","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}