Pattern and predictors of drug resistance and treatment outcome in tuberculosis patients at the centers of programmatic management of drug-resistant tuberculosis in Lahore, Pakistan

Globally, the prevalence of drug-resistant (DR-TB) tuberculosis is rising, and Pakistan is currently one of the nations with the highest burden. It is imperative to track changes in the prevalence of DR-TB, particularly the extensively drug-resistant (XDR-TB) tuberculosis, and identify the pattern of treatment outcome. To identify the pattern and predictors of drug resistance and treatment outcome in tuberculosis patients at the Centers for Programmatic Management of Drug-resistant Tuberculosis (PMDT) in Lahore, Pakistan. A cross-sectional analytical study was done in three PMDT centers (Programmatic Management of Drug-resistant Tuberculosis) in District Lahore. Secondary data of 387 were accessed, including files of patients of all ages and both genders enrolled during 2021. Data was collected from April to July, 2023. SPSS version 24 was used to enter the data. Information on drug resistance categories, pattern, socio-demographic and disease-related factors, adverse events, and treatment outcomes were gathered. RR resistance was found in 32.8% (127/387), MDR in 45.0% (174/387), Pre-XDR-TB in 21.2% (82/387) and XDR-TB in the remaining 1.0% (4/387). Drug-resistant TB was Pulmonary in 373/387 (96.4%) patients, while 3.6% were extra-pulmonary. 54.3% (210/387) males were enrolled with Drug-Resistant Tuberculosis with pre-dominantly RR-TB 38.1% (80/387). The mean age of 387 drug-resistant TB patients was 38.43 with SD of 17.190. Age (p-value = 0.007) and gender (p-value = 0.047) have been found significantly associated with the DRTB groups. The highest proportion (44.6%) of all types of comorbidities were observed in the MDR-TB group and being lowest (18.5%) in Pre-XDR/XDR TB group. Prior TB history was present in 65.1% (252/387) patients with majority in MDR group (46.4%). DR-TB arthralgia was the most common adverse event at 21%. The highest number of adverse events (adverse event = 208) were observed in DRTB cases who were administered with Pyrazinamide drug and the least adverse events were observed among DRTB cases taking Amikacin (adverse event = 9) and MFX (adverse event = 2). In 53.6% patients the treatment was successful, while 15.3% died. Drug resistant tuberculosis patients had a high death rate and multiple adverse events associated with the treatment. Multipronged strategies need to be designed to improve treatment success, minimize adverse events and increase awareness about DR-TB.