Factors Associated with the Development of Secondary Multidrug‑resistant Tuberculosis

Abstract

Background: Spread of multidrug‑resistant tuberculosis (TB) is a threat to India’s TB control program. We conducted this study with the objective to determine the risk factors for the development of secondary multidrug‑resistant TB.

Methods: We conducted an unmatched case–control study involving 247 multidrug‑resistant TB patients as “cases” and 494 individuals who were declared as “cured” after category I DOTS treatment as “controls.” Data were collected through face‑to‑face
interviews and review of treatment records. Multivariable logistic regressions were used to analyze the collected data.

Results: The mean duration for which cases took frst‑line anti‑TB drug was
19.7 months. The mean duration between initial diagnosis of TB and diagnosis of multi‑drug resistant TB (MDR‑TB) was 28.3 months. In our study, 26.7%, 50.2%, and 23.1% of MDR‑TB cases had one, two, or more previous episodes of TB before being diagnosed as MDR‑TB. In multivariable analysis, low or no formal education (album‑oriented rock [AOR] =1.63 [confdence interval (CI) = 1.03–3.11]), labor occupation (AOR = 2.15 [CI = 1.18–3.90]), smoking (AOR = 2.56 [CI = 1.19–
3.26]), having HIV (AOR = 9.45 [CI = 6.80–15.9]), migration for job (AOR = 3.70 [CI = 1.96– 5.67]), stopping TB treatment due to comorbid conditions (AOR = 8.86 [CI = 5.45–11.2]), and having type 2 diabetes (AOR = 3.4 [CI = 1.96–5.16]) were associated with MDR‑TB.

Conclusions: Government of India should devise strategy to prevent interruption of treatment to stop the emergence and spread of MDR‑TB. We need to better integrate TB control activities with diabetes and tobacco control programs for better health outcome among patients.

Keywords: India, multidrug resistance, risk factors, tuberculosis