Risk factors for drug-resistant tuberculosis in the cattle-corridor region of south-western Uganda: a case-control study

Abstract Background Drug-resistant tuberculosis remains a major threat to tuberculosis control in high-burden settings. In Uganda, the Ankole region of south-western Uganda lies within a cattle corridor characterised by rural livelihoods, close human–animal interaction, and variable access to tuberculosis services. Despite persistent notification of drug-resistant tuberculosis in the region, context-specific evidence on individual, social, community, and health-system risk factors remains scarce. We aimed to identify factors associated with drug-resistant tuberculosis among adults diagnosed with tuberculosis in the Ankole region. Methods We did a 1:3 individually matched case-control study among adults aged 18 years or older diagnosed with tuberculosis in public health facilities in Ankole region between Jan 1, 2023, and Sept 30, 2024. Cases were all eligible participants with drug-resistant tuberculosis confirmed using WHO-recommended molecular tests. For each case, up to three controls with drug-susceptible tuberculosis were systematically sampled from facility tuberculosis registers and matched by health facility, sub-county, sex, and age within ± 2 years. Data were collected using a structured questionnaire. We used generalised linear models with a log link to estimate adjusted prevalence ratios. Results We enrolled 131 participants: 34 cases and 97 controls. Drug-resistant tuberculosis was associated with previous tuberculosis treatment (adjusted prevalence ratio [aPR] 2·0, 95% CI 1·3–3.0; p = 0.001), chronic medical conditions (aPR 1.8, 95% CI 1.2–2.6; p = 0.001), daily alcohol consumption (aPR 2.3, 95% CI 1.7–3.0; p < 0.001), and low-income affecting access to tuberculosis care (aPR 1.5, 95% CI 1.1–2·0; p = 0.004). Tobacco smoking was inversely associated with drug-resistant tuberculosis (aPR 0.2, 95% CI 0.1–0.8; p = 0.019). Discussion Drug-resistant tuberculosis in Ankole was associated with previous treatment exposure, chronic illness, daily alcohol use, and financial barriers. Tuberculosis control in cattle-corridor settings should integrate retreatment follow-up, chronic disease care, alcohol-use interventions, and social protection.