BackgroundA major challenge for most tuberculosis programs is the inability of tuberculosis patients to complete treatment for one reason or another. Failure to complete the treatment contributes to the emergence of multidrug-resistant TB. This study aimed to evaluate the risk factors for time to loss to follow-up treatment by considering death as a competing risk event among tuberculosis patients admitted to directly observed treatment short course at Ambo General Hospital, Ambo, Ethiopia.MethodsData collected from 457 tuberculosis patients from January 2018 to January 2022 were used for the analysis. The cause-specific hazard and sub-distribution hazard models for competing risks were used to model the outcome of interest and to identify the prognostic factors associated to treatment loss to follow-up. Loss to follow-up was used as an outcome measure and death as a competing event.ResultsOf the 457 tuberculosis patients enrolled, 54 (11.8%) were loss to follow-up their treatment and 33 (7.2%) died during the follow up period. The median time of loss to follow-up starting from the date of treatment initiation was 4.2 months. The cause-specific hazard and sub-distribution hazard models revealed that sex, place of residence, HIV status, contact history, age and baseline weights of patients were significant risk factors associated with time to loss to follow-up treatment. The findings showed that the estimates of the covariates effects were different for the cause specific and sub-distribution hazard models. The maximum relative difference observed for the covariate between the cause specific and sub-distribution hazard ratios was 12.2%.ConclusionsPatients who were male, rural residents, HIV positive, and aged 41 years or older were at higher risk of loss to follow-up their treatment. This underlines the need that tuberculosis patients, especially those in risk categories, be made aware of the length of the directly observed treatment short course and the effects of discontinuing treatment.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13690-023-01130-2.