Risk Factors for Mortality Among Patients Diagnosed With Multi-Drug Resistant Tuberculosis In Uganda- A Case-Control Study

Abstract Background: The World Health Organization (WHO) End TB strategy aims to reduce mortality due to tuberculosis (TB) to less than 5% by 2035. However, mortality due to multidrug-resistant tuberculosis (MDR-TB) is particularly high and stood at 15% globally in 2018. In Uganda, MDR-TB associated mortality was 19% in the same year. We set out to examine the risk factors for mortality among a cohort of patients diagnosed with MDR-TB in Uganda. Methods: We conducted a case-control study nested within the national MDR-TB cohort. We defined cases as patient who died from any cause during the two years following treatment initiation. We selected two controls for each case from patients alive and on MDR-TB treatment at the time that the death occurred (incidence-density sampling) and matched the cases and controls on health facility at which they were receiving care. We performed conditional logistic regression to identify the risk factors for mortality. Results: Data from 198 patients (66 cases and 132 controls) started on TB from January 1 to December 31, 2016, was analyzed for this study. Majority of patients (60.6%) were male and were HIV positive (59.6%). About half (46.0%) were aged 19-34 years. On multiple regression analysis, co-infection with HIV (aOR 1.9, 95% CI [1.1-4.92]p=0.05); non-adherence to TB treatment (aOR 1.92, 95% CI [1.02-4.83] p=0.04); age over 50 years (aOR 3.04, 95% CI [1.13-8.20] p=0.03); and not having any education (aOR 3.61, 95% CI [1.1-10.4] p=0.03) were associated with MDR TB mortality. Conclusion: To improve MDR-TB treatment outcomes, to attention must be paid to provision of social support particularly for older persons on MDR TB treatment. Interventions that support treatment adherence and promote early detection of HIV infection should also be emphasized for all persons diagnosed with TB.