Drug-resistance, treatment outcome and their predictors in pulmonary tuberculosis at Yirgalem General Hospital Multidrug-Resistance Tuberculosis treatment initiation center, Sidama Region, South Ethiopia: a Retrospective cohort study

Abstract Background : Tuberculosis (TB) is one of the oldest diseases known and the spread of drug-resistant TB poses significant challenges in TB control and eradication program globally, and also the distribution varies geographically worldwide and within the countries. Lack of universal access to rapid diagnostic test, poor infection control and mismanagement of TB at different level increases the spread of DR-TB. The final treatment outcome of patient implicates the level of program implementation in TB control. The current study aimed to assess the proportions of drug-resistance, treatment outcome and their predictors among pulmonary MDR/RR-TB treated patients. Methods : A six year, 2014 to 2019 retrospective cohort review was conducted for all confirmed pulmonary DR-TB cases admitted at Yirgalem General Hospital treatment initiation center. The records of 228 total MDR/RR-TB cases 32 cases, such as referral cases outside the study area, extra pulmonary tuberculosis and incomplete data were excluded. Results: Overall, 196 MDR/RR-TB patients included in the study. 184(93.9%) cases were labeled as rifampicin (RIF) mono-drug resistance and 8 (4.1%) cases had resistance to both Isoniazid and Rifampicin (MDR-TB) while 4 (2%) patients were diagnosed for additional resistance for second line drugs (SLDS) at the enrollment. Overall, 131(68.9 %) patients had the recorded treatment success in which 86 (43.9%) patients declared cured while 27(13.8%) declared completed treatment. The trend of successful treatment outcomes fluctuates over the years. The proportion declines from 81.9% in 2014 to 52.4% in 2016. Unsuccessful treatment in cohort was 65(31.1%) of MDR-TB. Of which 18(9.2%) were died during the treatment course while 27(13.8%) and 6(3.1%) were LTFU and treatment failure respectively. multivariate analysis revealed, being above age greater than 26 (AOR: 1.45; 95%CI: 1.044, 2.006), co-morbid disease other than HIV (AOR: 1.71; 95%CI: 0.937, 12.618), baseline positive sputum smear (AOR: 0.54; 95%CI: 0.375, 0.789) were significantly associated with unfavorable treatment outcomes with P-value<0.05. Conclusion : 2% additional resistance for SLDs is alarming. Treatment success rate was lower than targeted set by World health organization. Factors affecting poor treatment outcome in MDR-TB management needs to be addressed through targeted interventions. Strengthened TB control strategies should in place to reduce further transmission of drug resistance.