TREATMENT OUTCOMES AMONG MULTI DRUG RESISTANT TB PATIENTS VISITING PUBLIC HOSPITAL OF SINDH

Abstract

Background: Multidrug-resistant tuberculosis (MDR-TB) remains a critical public health issue in Pakistan, particularly in high-burden regions like Sindh. The disease poses significant treatment challenges due to prolonged regimens, drug-related toxicities, and poor adherence, all of which contribute to unfavorable patient outcomes. Understanding treatment success rates and identifying factors influencing outcomes are essential to strengthen the national tuberculosis response.

Objective: To evaluate treatment outcomes among microbiologically confirmed pulmonary MDR-TB patients managed at a public sector hospital in Sindh and to identify demographic, clinical, and program-related factors associated with unfavorable outcomes.

Methods: A retrospective cohort study was conducted at a designated public hospital in Sindh. The study included 212 microbiologically confirmed pulmonary MDR-TB patients aged 15 years and above who were enrolled in outpatient treatment between January 2018 and December 2022. Patients with extensively drug-resistant TB, those transferred out, or lacking documented final outcomes were excluded. Data were extracted from hospital TB registers and treatment cards. Treatment outcomes were classified according to WHO and National Tuberculosis Control Programme (NTP) guidelines. Descriptive statistics and multivariate logistic regression were performed using SPSS version 29.

Results: Among the 212 patients, 130 (61.3%) achieved favorable outcomes—90 (42.5%) were cured and 40 (18.9%) completed treatment. Unfavorable outcomes were noted in 82 patients (38.7%), including 30 (14.2%) who died, 12 (5.7%) who failed treatment, 30 (14.2%) lost to follow-up, and 10 (4.7%) not evaluated. Younger patients (<30 years) had the highest favorable outcome rate (83.3%), while those aged ≥50 had the lowest (38.5%). New cases had slightly better outcomes (62.5%) than previously treated cases (60.6%). Patients without comorbidities had better success (63.3%) compared to those with comorbidities (48.4%). Loss to follow-up and poor adherence significantly predicted unfavorable outcomes.

Conclusion: Treatment success for MDR-TB in Sindh remains below global targets. Strengthening patient-centered care, improving adherence strategies, and enhancing follow-up systems are critical for better disease control in high-burden settings.