Social determinants and co-morbidities of patients with extensively drug resistant tuberculosis

The aim of this study is to identify the most significant social determinants and co-morbidities of patients with extensively drug resistant tuberculosis (XDR-TB). <b>Methods:</b> Case-control analysis of treatment outcomes among 67 patients with XDR and 122 drug sensitive (DS) TB patients (non HIV infected) was conducted in 2015-2018. Bivariate and multivariable logistic regression analysis was used to identify the determinants associated with XDR-TB. <b>Results:</b> Social TB-risk factors were identified in 91.0% and 68.0% of XDR and DS TB patients. XDR-TB was found in 31.3% and 75.6% of the new and previously treated patients. The most significant social determinants of XDR-TB were identified: absence of constant place of work before TB (Odds ratio (OR) = 3.57; 95% Confidence Interval (CI) = 1.32–10.14), low educational qualification (OR = 3.18; 95% CI = 1.24–8.97), history of imprisonment (OR = 2.68; 95% CI = 1.21–7.56), loneliness (OR = 3.89; 95% CI = 1.72–9.94), alcohol abuse (OR = 2.81; 95% CI = 1.16–7.75), and smoking (OR = 2.32; 95% CI = 1.24–7.56). 72.9% of patients were heavy smokers who smoked more than one pack of cigarettes a day. Medical risk factors for XDR-TB were listed: TB treatment interruptions (OR = 4.23; 95% CI = 1.16–19.07), three chronic diseases (OR = 3.51; 95% CI = 1.27–11.34). Chronic obstructive pulmonary disease was found to be the most frequent disease and registered in 63.9%. <b>Conclusion:</b> XDR-TB is characterized by a high level of social problems among the patients. In order to reduce the spread of extensively drug resistant tuberculosis, strategies of controlling XDR-TB should focus on multi-sectorial actions, addressing health care and social needs of TB patients.