Outcomes of multidrug-resistant tuberculosis in Zambia: a cohort analysis

Infection. 2017 Dec;45(6):831-839. doi: 10.1007/s15010-017-1054-8. Epub 2017 Aug 4.


Purpose: The purpose of this study was to establish a baseline for measuring the impact of the programmatic management of drug-resistant TB program by following up on outcomes of all patients diagnosed with multidrug-resistant tuberculosis in Zambia between 2012 and 2014.

Methods: A cohort study of all the MDR-TB patients diagnosed at the national TB reference laboratory from across Zambia. MDR-TB was diagnosed by culture and DST, whereas outcome data were collected in 2015 by patient record checks and home visits.

Results: The total number of patients diagnosed was 258. Of those, 110 (42.6%) patients were traceable for this study. There were 67 survivor participants (60.9%); 43 (39.1%) were deceased. Out of the 110 patients who were traced, only 71 (64.5%) were started on second-line treatment. Twenty-nine (40.8%) patients were declared cured and 16.9% were still on treatment; 8.4% had failed treatment. The survival rate was 20.2 per 100 person-years of follow-up. Taking ARVs was associated with a decreased risk of dying (hazard ratio 0.12, p = 0.002). Sex, age, marital status and treatment category were not important predictors of survival in MDR-TB patients.

Conclusions: More than half of the patients diagnosed with MDR-TB were lost to follow-up before second-line treatment was initiated.

Keywords: Drug resistance; MDR-TB; Treatment outcome; Tuberculosis; Zambia.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antitubercular Agents / therapeutic use*
  • Cohort Studies
  • Drug Resistance, Multiple, Bacterial*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mycobacterium tuberculosis / drug effects
  • Mycobacterium tuberculosis / physiology*
  • Treatment Failure
  • Tuberculosis, Multidrug-Resistant / drug therapy*
  • Tuberculosis, Multidrug-Resistant / mortality
  • Young Adult
  • Zambia / epidemiology


  • Antitubercular Agents