Monitoring and follow-up of patients with pulmonary tuberculosis in a war context at Virunga General Hospital : causes leading to therapeutic failure in Goma, Democratic Republic of Congo

Treatment failure in pulmonary tuberculosis (TB) remains a major obstacle to TB control, particularly in conflict-affected and resource-limited settings where continuity of care and treatment adherence are frequently compromised. Identifying context-specific determinants of therapeutic failure is essential for improving treatment outcomes and preventing drug resistance. We conducted a retrospective comparative study at Virunga General Referral Hospital in Goma, eastern Democratic Republic of Congo, using routine clinical records of patients treated for pulmonary tuberculosis between January and December 2024. Patients with therapeutic failure were compared to those declared cured. Sociodemographic, adherence-related, patient-related, and health system factors were analyzed using bivariate analysis and multivariate logistic regression to identify independent predictors of treatment failure. Statistical significance was set at p < 0.05 with a 95% confidence interval (CI). A total of 197 patients were included, of whom 24 (12.18%) experienced therapeutic failure. In bivariate analyses, therapeutic failure was significantly associated with occupational status (p = 0.027), non-adherence to directly observed therapy (DOT) (p = 0.030), failure to adhere to prescribed medication schedules (p = 0.007), missed clinic appointments (p = 0.001), and loss to follow-up (p < 0.001). Multivariate logistic regression identified absence of occupational activity as the only independent predictor of therapeutic failure (adjusted OR = 3.59; 95% CI: 1.23–10.3; p = 0.017). Other factors, including age, sex, residence, comorbidities, treatment interruption, and health service-related variables, were not independently associated with treatment failure after adjustment. Therapeutic failure among pulmonary TB patients in this conflict-affected setting remains substantial. The strong association between unemployment and treatment failure underscores the critical role of socioeconomic vulnerability in TB outcomes. These findings highlight the need for TB control strategies that integrate social support mechanisms alongside medical management, particularly for economically disadvantaged patients, to improve treatment adherence and reduce failure rates in unstable contexts.