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Aims and Objectives: To evaluate tuberculosis treatment outcomes in a Nigerian tertiary-care setting and to identify factors associated with unsuccessful treatment outcome., Patients and Methods: Retrospective audit of tuberculosis patients registered for treatment from January 2006 to December 2010 at Federal Medical Centre Abakaliki, Nigeria. Six treatment outcome criteria were assessed based on guidelines set by the World Health Organisation (WHO). Analysis was conducted using SPSS. Multivariable logistic regression analysis were used to identify independent predictors for unsuccessful treatment outcome and statistical significance was taken as P <0.05., Results: A total of 671 patients (55% male, 45% female) with a mean age of 36.4 years were registered for treatment; 147 (22%) were smear-positive, 270 (40%) smear-negative and 254 (38%) had extra-pulmonary tuberculosis. Also, 189 (28.2%) of them were HIV positive and; 341 (51%) lived in a rural area. Overall, 387 patients (57.7%) had a successful treatment outcome and 284 (42.3%) had an unsuccessful treatment outcome. Of the patients with unsuccessful treatment outcome, 192 (67.6%) had defaulted, 55 (19.4%) had died, 3 (1%) had treatment failure and 34 (12%) were transferred-out. Nil significant change in trend of treatment success over the study period [P = 0.75 for trend]. In multivariable analysis, unsuccessful treatment was associated with older age (aOR = 2.3), rural residence (aOR = 2.1), smear negative PTB (aOR=1.6), being on retreatment (aOR 3.8), and HIV seropositivity (aOR=1.7)., Conclusion: Treatment success rate was poor; targeted measures should be considered to improve treatment success among identified high-risk groups.