Determinants of multidrug resistance amongst turberculosis patients in Matabeleland North and Bulawayo Metropolitan provinces, 2013

Abstract

Introduction: Multidrug resistance tuberculosis is an emerging threat to the management of TB in Zimbabwe. The aim of the study was to investigate the determinants of MDR-TB in Matabeleland North and Bulawayo Metropolitan Provinces of Zimbabwe. Methods: A case control study was conducted. Eighty cases and two hundred and forty controls were enrolled into the study. Cases were randomly selected from a line list of MDR-TB cases diagnosed via susceptibility testing between 2011 and 2013. Controls were randomly selected from those who had tested negative for MDR-TB via sensitivity testing. Bivariate analysis and stratified analysis were conducted. Stepwise forward logistic regression was used to control for confounding and assess for effect modification. Results: Risk factors for MDR-TB were: history of contact with MDR-TB case (AOR= 4.46, 95% CI; 2.02-9.88), history of hospitalization (AOR= 2.91 95% CI; 1.62-5.23) and travel outside Zimbabwe (AOR= 2.68 95% CI; 1.46-4.91). Protective factors were: “successful outcome” on previous treatment (AOR= 0.05 95% CI; 0.02-0.11), history of prior treatment supervision by a Health Worker or Village Health Worker (AOR= 0.34 95% CI; 0.19-0.60) and having been treated not more than once before for TB (AOR= 0.18 95% CI; 0.08-0.38). There was no association between HIV infection and MDR-TB (AOR=1.00 95% CI; 0.53-1.88). Patients with a CD4 of less than 200 were more likely to develop MDR-TB (AOR= 4.62 95% CI; 2.49-8.53). Conclusion: Treatment interruption, contact with MDR-TB cases, history of travel outside Zimbabwe, history of hospitalization, two or more previous TB episodes and history of previous TB medicines side effects are significant risk factors for MDR-TB in Bulawayo and Matabeleland South provinces. A successful outcome during previous treatment and being supervised by a Health Worker or a Village Health Worker are significantly protective against having MDR-TB in both provinces. To reduce the MDR-TB burden in Zimbabwe, contact tracing for all MDR-TB patients and continuous adherence counseling during TB treatment need to be strengthened. All TB patients need to be supervised by either Health Workers or Village Health Workers during TB.