Background:

India is estimated the carry the highest burden of multidrug-resistant tuberculosis (MDR-TB). Within an ongoing cross-sectional study on pathways to TB care, we assessed patient level risk factors associated with MDR-TB.

Design/Methods:

We interviewed 264 non-MDR and 123 rifampicin-resistant/MDR patients confirmed by Xpert and registered with the Revised National TB Control Program in Pune from Jan 2018-Feb 2019. We performed univariate and multivariate logistic regression analysis of risk factors in association with MDR-TB vs. non-MDR-TB.

Results:

History of prior TB was strongly associated with MDR (adjOR 6.88; 95%CI 4.02-11.76; P<0.001), in addition hours spent in crowded locality, alcohol use, and household income were associated with MDR (adjOR respectively 1.09 per hour, 95%CI 1.04-1.15, P 0.005; 2.72, 95%CI 1.15-6.40, P 0.022; 1.03 per 10,000 rupees, 95%CI 1.01-1.05, P 0.007). On the other hand tobacco use and patient age was negatively associated with MDR (adjOR respectively 0.43, 95%CI 0.19-0.95, P 0.037; 0.97 per year, 0.95-0.99, P 0.007). Although female gender was significantly associated with MDR-TB in univariate analysis (OR 1.78 95% CI 1.13-2.82, Fisher P 0.009), we found gender to be confounded by time in crowded locality and age (adjOR 1.25, 95%CI 0.63-2.5, P 0.52).

Conclusion:

We identify a strong association between crowding and MDR-TB suggesting that recent transmission of MDR is particularly acute in our study area. This is also supported by the observed association between younger age and MDR. Active screening of identified vulnerable groups is strongly recommended.