Factors associated with unfavorable treatment outcomes among multidrug-resistant tuberculosis patients, Sierra Leone: A cross-sectional secondary data analysis

Abstract

Abstract Background Multidrug-resistant tuberculosis (MDR-TB) is a major public health problem globally. The tuberculosis rate in Sierra Leone is 298 per 100,000 people, and it is considered a country with a high burden of tuberculosis. In Sierra Leone, there is limited information on the outcomes of the treatment of MDR-TB, especially those exacerbated by COVID-19. We identified factors associated with unfavorable treatment outcomes among patients with MDR-TB in Sierra Leone. Methods We conducted a cross-sectional study to analyze hospital-based MDR-TB data for 2017 to 2021. Demographic, clinical, and treatment outcome data were extracted 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 the outcomes of MDR-TB treatment. Results Between 2017 and 2021, 628 patients with MDR-TB were reported in the 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 percent (440) of MDR-TB patients received tuberculosis treatment. The majority of patients, 457 (73%), were treated with the short treatment regimen, and 126 (20%) experienced unfavorable 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) are significantly associated with unfavorable treatment outcome for DR-TB. Conclusions This analysis found a high proportion of unfavorable treatment outcomes among MDR-TB patients in Sierra Leone. Malnourishment, TB retreatment, HIV co-infection, and people aged 45 years were associated with unfavorable outcomes of MDR-TB treatment. 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.