Factors associated with unfavorable treatment outcomes among multidrug-resistant tuberculosis patients, Sierra Leone, 2017 to 2021

  • Anti-microbial resistance
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Multidrug-resistant tuberculosis (MDR-TB) is a major public health problem globally. The tuberculosis rate in Sierra Leone is 298 per 100,000 population, and it is considered a high tuberculosis burden country. In Sierra Leone, there is limited information regarding MDR-TB treatment outcomes, especially those exacerbated by COVID-19. We identified factors associated with unfavorable treatment outcomes among MDR-TB patients in Sierra Leone.

We conducted a cross-sectional study to analyse hospital-based MDR-TB data for 2017 to 2021. Demographic, clinical, and treatment outcome data were abstracted from the main MDR-TB referral hospital database. We defined unfavorable outcomes as patients who died, were lost to follow-up, or defaulted. We calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) to identify predictors of MDR-TB treatment outcomes.

Between 2017 and 2021, 628 MDR-TB patients were reported at Lakka hospital; 441 (71%) were male, with a median age of 34 years (range: 1-70). Clinically, 21 % of the 628 MDR-TB patients were HIV-positive, and 413 were malnourished (66 %). Seventy per cent (440) of MDR-TB patients were receiving tuberculosis treatment. The majority of patients, 457 (73 %), were treated with the short treatment regimen, and 126 (20 %) experienced unfavourable outcomes. Age group less than 20 years (aOR=5.08; CI:1.87 – 13.82), tuberculosis retreatment (aOR=3.23; CI:1.82 – 5.73), age group 21- 45 years (aOR=2.22; CI:140 – 3.54), HIV (aOR=2.16; CI:1.33 – 3.53), malnourishment (aOR=1.79; CI:1.12 – 2.86).

This analysis found a high proportion of unfavorable treatment outcomes among MDR-TB patients in Sierra Leone. Malnourishment, TB retreatment, HIV co-infection, and young age were predictors of unfavorable MDR-TB treatment outcomes. Increasing patients’ awareness, mainly among the youngest, heightens treatment adherence and HIV monitoring can reduce adverse treatment outcomes in Sierra Leone and other Sub-Saharan African countries.

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