Characteristics and Treatment Outcomes of Patients with Drug-Resistant Tuberculosis in Selected Facilities of O.R. Tambo District Municipality, Eastern Cape, South Africa: A Retrospective Cohort Study

Background: Tuberculosis (TB) remains a major global health concern, particularly in low- and middle-income countries, due to its high prevalence, mortality, and economic impact. The emergence of drug-resistant tuberculosis (DR-TB) has intensified this burden, posing significant challenges to disease control and management. Understanding the epidemiology of DR-TB is crucial for improving prevention strategies, guiding treatment interventions, and informing public health policies aimed at reducing its spread and impact. Methods: A retrospective cohort study was conducted using medical records of patients diagnosed with DR-TB between January 2020 and December 2024 at decentralized DR-TB clinics in the O.R. Tambo District Municipality, Eastern Cape, South Africa. Treatment outcomes were collected from available records through August 2025. Data on demographic, clinical, and treatment outcome variables were collected using a structured abstraction tool. Data was analyzed using SPSS version 30 (IBM Corp., Armonk, NY, USA). Results: A total of 385 participants were included in the study, with a mean age of 38.6 years. Males accounted for 62.3% of cases. Most participants (94.3%) resided in rural areas, and 62% were HIV-coinfected. Rifampicin-resistant TB was the most common type (51%), followed by MDR-TB (38%). A significant association was observed between age and HIV status (p = 0.001). Treatment outcomes showed that 40.8% of patients were cured, while 11.7% died, with mortality highest among older and HIV-positive patients. Comorbidities reported included hypertension and diabetes mellitus. Conclusions: Most patients included in this facility-based cohort were males, aged 25–39 years, rural residents, living with HIV, with suboptimal treatment outcomes and a substantial comorbidity burden. Strengthened integrated TB/HIV care, early diagnosis, and targeted interventions are needed to improve DR-TB outcomes in this setting.