Factors Associated with the Development of Secondary Multidrug-resistant Tuberculosis

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 first-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 [confidence 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.