High prevalence of rifampin-resistant tuberculosis in mountainous districts of India

Indian J Tuberc. 2020 Jan;67(1):59-64. doi: 10.1016/j.ijtb.2019.08.005. Epub 2019 Aug 17.


Background: India accounts for quarter of global rifampin-resistant/multi-drug resistant-tuberculosis (RR/MDR-TB). Knowledge on risk-factors and distribution of MDR-TB at district level is limited.

Objective: Study prevalence and risk factors of MDR-TB in tuberculosis patients in hilly districts of Himachal Pradesh, India.

Methods: Between July 2012-June 2013, TB patients registered under the Revised National Tuberculosis Control Program in Kangra and Una districts suspected of MDR-TB were referred for Xpert® MTB/RIF testing at the Delek Hospital, Dharamsala by the district TB Office.

Results: Of 378 patients enrolled (median age: 45 years; 85% males), 18% (n = 68) were rifampin-resistant. Among Xpert positives (n = 305), distributions of RR-TB were: 10% (n = 9/89) for recurrent cases who had received TB treatment for <2-months, 15% each for new (n = 9/59) or recurrent cases (n = 5/34) remaining smear positive between 2 and 4 months of treatment, 36% (n = 41/113) for treatment failures, and 40% (n = 2/5) for loss to follow-ups. Of the sputum-smear positives, 15% (n = 51/338) were Xpert negative. Seeking care in the private sector was associated with higher risk of RR-TB (OR:1.85; 95% CI:0.87-3.9).

Conclusion: Prevalence of RR-TB is generally high in patients suspected of MDR-TB in the hilly districts of Himachal Pradesh. High prevalence during early phase of treatment can suggest primary transmission of DR-TB. Universal drug susceptibility testing and innovative case finding strategies will benefit patients living in mountain districts with inadequate access to healthcare. The high proportion of sputum-smear positive but Xpert negative cases may be due to non-tubercular mycobacterial disease.

Keywords: Himachal Pradesh; India; Multidrug resistant tuberculosis; Tuberculosis.

MeSH terms

  • Adult
  • Antibiotics, Antitubercular*
  • Drug Resistance, Bacterial / genetics
  • Female
  • Health Services Accessibility
  • Humans
  • India
  • Male
  • Middle Aged
  • Mycobacterium tuberculosis / genetics
  • Nucleic Acid Amplification Techniques
  • Patient Acceptance of Health Care
  • Prevalence
  • Private Sector
  • Rifampin*
  • Risk Factors
  • Tuberculosis, Multidrug-Resistant / diagnosis
  • Tuberculosis, Multidrug-Resistant / epidemiology*
  • Tuberculosis, Multidrug-Resistant / microbiology
  • Tuberculosis, Multidrug-Resistant / transmission


  • Antibiotics, Antitubercular
  • Rifampin