Multidrug Resistant Tuberculosis in Sierra Leone

Abstract

Background: Multidrug-resistant tuberculosis (MDR-TB) remains a global health crisis. This study assessed treatment outcomes and identified social and health factors linked to poor outcomes among people with MDR-TB in Sierra Leone. Methods: A national retrospective cohort study included all individuals diagnosed with MDR-TB and admitted to Lakka Hospital between April 2017 and September 2019, with follow-up to May 2021. Eligible participants received WHO-recommended short or long aminoglycoside-containing regimens. Multivariable logistic regression was used to identify factors associated with adverse outcomes (death, treatment failure, or loss to follow-up). Results: Of 370 MDR-TB cases, 365 were eligible, and 341 (93%) initiated treatment. Treatment success was achieved in 267 (73%) participants, while 95 (26%) had adverse outcomes. Factors significantly associated with poor outcomes included older age, severe undernutrition, untreated HIV, chronic lung disease, prior TB retreatment, and receiving the long regimen. Resistance to prothionamide and aminoglycoside-induced deafness were also linked to adverse outcomes. Conclusion: TB treatment outcomes in Sierra Leone approached WHO targets, particularly with the short regimen. Findings highlight the importance of integrated care—including HIV and chronic disease management—and the need to expand access to all-oral regimens.