S86 Predictors of adverse treatment outcomes among people with drug-resistant tuberculosis in Sierra Leone: a national, retrospective cohort study

<h3>Background</h3> Drug-resistant tuberculosis (DR-TB) is a global public health emergency. In April 2017, the National Tuberculosis Programme (NTP) of Sierra Leone, a high TB burden country, began using WHO-approved second-line drugs in short and long DR-TB treatment regimens. We analysed treatment outcomes for people with DR-TB to inform future refinements in DR-TB healthcare provision. <h3>Methods</h3> This national, retrospective cohort study recruited all people notified with DR-TB (rifampicin or multi-drug resistant) in Sierra Leone between April 2017 and September 2019 and followed-up to June 2020. We used NTP register data routinely collected at diagnosis to construct a multivariable logistic regression model of baseline sociodemographic and health characteristics associated with WHO-defined adverse treatment outcomes including death, loss to follow-up, treatment failure, or no evaluation. <h3>Findings</h3> 365 people with DR-TB were notified and 331/365 (91%) started treatment. Median age was 35 years (IQR=26–45), 263/365 (72%) were male, 51/365 (14%) HIV-positive, 127/365 (35%) severely underweight (BMI&lt;16.5), 12/365 (3.3%) had chronic renal disease, and 82/365 (22%) had chronic lung disease. 234/365 (64%) people had treatment success, 87/365 (24%) adverse outcome, and 44/365 (12%) were still on treatment. People receiving the short regimen had the highest success rates (figure 1). Of those who never started treatment, 21/24 (88%) died. Factors associated with adverse outcome <i>vs</i> treatment success were age 45–64 years (adjusted odds ratio [aOR]=2.8, 95%CI=1.3–6.1), severe underweight (aOR=4.1, 95%CI=1.8–9.6), chronic renal disease (aOR=5.6, 95%CI=1.4–22) and chronic lung disease (aOR=2.3, 95%CI=1.1–4.8). <h3>Conclusions</h3> DR-TB treatment success rates in Sierra Leone were similar to global rates. People receiving short DR-TB regimens had the highest treatment success rates. Underweight, older age, advanced disease, and non-communicable comorbidities (NCDs) were associated with adverse DR-TB treatment outcomes. These findings suggest nutritional support, active case-finding, and linkage with NCD management should be evaluated as potential strategies to mitigate adverse DR-TB outcomes in Sierra Leone.