Factors associated with multidrug-resistant tuberculosis among people living with HIV in Addis Ababa, Ethiopia: a case-control study

Abstract Background Tuberculosis (TB) remains a leading cause of morbidity and mortality globally, particularly in developing countries. Multidrug-resistant TB (MDR-TB), defined as resistance to at least isoniazid and rifampicin, poses a serious public health challenge. People living with HIV (PLWHIV) are 16 times more likely to develop TB than HIV-negative individuals, and TB is the leading cause of death in this population. Despite this, evidence on the specific factors associated with MDR-TB among PLWHIV in Addis Ababa remains limited. This study aimed to identify factors associated with MDR-TB among PLWHIV in Addis Ababa, Ethiopia. Methods A facility-based unmatched case control study was conducted from June 15 to July 15, 2024, in three MDR-TB treatment hospitals in Addis Ababa. Cases were HIV-positive patients with GeneXpert/culture-confirmed MDR-TB, while controls were HIV-positive patients who were declared cured or had successfully completed first-line anti-TB treatment. Participants were selected using simple random sampling, with a 1:1 case-to-control ratio (117 cases and 117 controls). Data were analyzed using binary and multivariable logistic regression; adjusted odds ratios (AOR) with 95% confidence intervals (CI) were used to measure associations. Results A total of 234 respondents (117 cases and 117 controls) participated in this study. Four factors were independently associated with MDR-TB development: Residence in Addis Ababa (AOR: 4.17, 95% CI: 1.96–8.77), contact history with a known MDR-TB patient (AOR: 9.09, 95% CI: 3.70–22.37), prior TB treatment (AOR: 5.56, 95% CI: 2.33–13.3), and living in rooms without windows (AOR: 6.10, 95% CI: 2.12–17.53). Conclusion Contact with known MDR-TB patients, prior TB treatment, urban residence in Addis Ababa, and poor home ventilation were significantly associated with MDR-TB among PLWHIV. Targeted interventions including strengthened contact tracing, strict adherence support during first-line treatment, and housing improvement are essential to curb MDR-TB transmission in this high-risk population.