Treatment outcomes of drug-resistant tuberculosis in Sabah, Malaysia – a retrospective cohort study

Objectives

Addressing drug-resistant tuberculosis (DR-TB) is a priority of the tuberculosis (TB) programme. People with DR-TB frequently have worse outcomes and require more costly and complex management, compared with those with drug-sensitive TB (DS-TB). Our study examined the epidemiology of DR-TB in Sabah, Malaysia, a state with high TB burden. We aimed to identify factors associated with poor treatment outcomes.

Study design

Retrospective cohort study.

Methods

Data were derived from a national registry of TB patients from Sabah. Descriptive analyses were used to characterise DR-TB epidemiology, including annual trends. Multivariable logistic regression was used to identify factors associated with poor DR-TB treatment outcomes.

Results

Between 2016 and 2021, there were 29,337 registered TB patients, of whom 158 (0.54 %) had DR-TB. The proportion of people with DR-TB between 2016 and 2019 was between 0.32 % and 0.47 % of annual total TB, increasing to 0.97 % in 2021. The proportion of people with DR-TB who were cured or completed treatment (63.1 %) was lower compared with DS-TB (86.0 %). In multivariable analysis, poor DR-TB treatment outcomes (death, lost to follow-up, failed treatment, transferred out & lost) were significantly associated with non-citizen status (adjusted odds ratio [aOR] = 2.49; 95 %CI 1.23–5.13) and male sex (aOR = 2.34; 95 %CI 1.15–4.94).

Conclusions

There was an increase in the proportion of TB that was DR-TB, coinciding with the COVID-19 pandemic in Sabah. Non-citizens and male sex were the most significant predictors of poor treatment outcomes among those with DR-TB.