Prevalence and associated factors of rifampicin resistance pulmonary tuberculosis among HIV-positive patients in Bahir Dar, Northwest, Ethiopia

Tuberculosis (TB) remains a major public health problem and a leading cause of morbidity and mortality among people living with HIV, particularly in high-burden countries such as Ethiopia. TB control is severely compromised by rifampicin-resistant TB (RR-TB) due to limited treatment options and poorer outcomes. This study aimed to determine the prevalence of rifampicin-resistant pulmonary TB and identify associated factors among HIV-positive patients in Bahir Dar, Northwest Ethiopia. An institution-based cross-sectional study was conducted among 174 HIV-positive patients with presumptive pulmonary TB attending tuberculosis clinic in Bahir Dar, Northwest Ethiopia from October to December 2025. Socio-demographic, behavioral, and clinical data were collected using a structured questionnaire and medical record review. Sputum samples were analyzed using the GeneXpert MTB/RIF assay for detection of Mycobacterium tuberculosis and rifampicin resistance. Bivariable and multivariable logistic regression analyses were performed to identify factors associated with rifampicin resistance. Statistical significance was set at p < 0.05. The prevalence of rifampicin resistance was 10.9%; found in 19 out of 174 presumptive TB patients. individuals who were widowed (AOR = 15.9; 95% CI 3.01-83.62) and divorced (AOR = 9.2; 95% CI 1.71-49.88) had considerably greater odds of rifampicin resistance than married people in multivariable analysis. Rifampicin resistance was 2.91 times more likely in participants with previous TB Treatment (95% CI 1.04-8.18, p = 0.042). There was an independent correlation between rifampicin resistance and smoking history (AOR = 3.4; 95% CI 1.02-11.49). The study revealed a high burden of rifampicin-resistant TB among HIV-positive patients in Bahir Dar. Significant predictors of rifampicin-resistant TB included social factors such as marital disruption, behavioral factors like smoking, and advanced HIV disease. Reducing the burden of RR-TB in HIV-infected populations requires strengthening early molecular diagnosis, increasing ART adherence, encouraging smoking cessation, and offering targeted social assistance for vulnerable groups.