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Determining the trends and treatment outcomes of TB in health facilities is very important to inform better management of the disease and control efforts. Nevertheless, data from the rural, urban and suburban settings of Ethiopia show variability and inconsistency. This study was designed to evaluate trends and treatment outcomes of tuberculosis patients at Tepi Health Center and to identify the predictors of unsuccessful treatment outcome. Retrospective review of TB cases registered in Tepi health center between June 2011 and May 2018