Pregnant women face delays starting tuberculosis treatment in Cape Town

Tuberculosis (TB) is most common in women during their reproductive years and is a leading cause of maternal death. Pregnant women with TB face particularly high risks of not starting treatment and of poor outcomes for both mother and baby. To understand how quickly pregnant women begin TB treatment after diagnosis, Sue-Ann Meehan and colleagues examined routine clinical records from a high-burden setting. They looked at women aged 15–45 who had laboratory-confirmed and/or clinically diagnosed TB between October 2018 and December 2020 in two sub-districts of Cape Town, South Africa. The team used linked electronic data from routine services to identify cases and compare pregnant and non-pregnant women. Their goal was to measure the time from diagnosis to the first dose of antituberculosis treatment and to see which factors influenced whether and when treatment began. By studying care delivered in ordinary health services rather than in a clinical trial, the researchers aimed to reveal real-world gaps in timely treatment for pregnant women with TB.

The study included 5,459 women with TB, of whom 292 (5.3%) were pregnant at diagnosis. Pregnant women were slightly younger: median age 28.6 years (IQR: 23.7–33.7) versus 31 years (IQR: 25.2–36.5) for non-pregnant women. HIV prevalence was similar between groups (177/292; 60.6% in pregnant women versus 3,200/5,167; 61.9% in non-pregnant women). The researchers used time-to-event analysis to calculate the interval from TB diagnosis to the start of antituberculosis treatment and applied Cox regression to assess determinants of treatment initiation. Median time to treatment initiation was two days for both groups, and most women began therapy within the first month after diagnosis. After that first month the rate of starting treatment plateaued. Over a six-month follow-up, time to treatment initiation differed between groups (Kaplan Meier Log-rank test, p = 0.0064), with pregnant women lagging behind non-pregnant women. The study also found that almost 15% of women never started TB treatment.

These findings show that while many pregnant women in this Cape Town setting do begin TB treatment quickly, a meaningful minority experience delays or never start therapy. The fact that median time to initiation was only two days is encouraging, but the plateau after one month and the statistical lag for pregnant women highlight a gap in care. Because TB during pregnancy contributes to maternal mortality and can worsen both treatment and pregnancy outcomes, the study suggests a clear need for targeted actions. The authors conclude that strategic interventions should prioritise early treatment initiation, and that special attention must be paid to pregnant women who have not started treatment within one month of diagnosis. In routine health services, tracking and follow-up systems that flag pregnant women beyond the first month after diagnosis could help close this gap and improve outcomes for mothers and babies.