Prevalence and contributing factors of drug-resistant tuberculosis (DR-TB) in iran: a systematic review

Drug-resistant tuberculosis (DR-TB) is an increasing public health concern in Iran, with multidrug-resistant tuberculosis (MDR-TB) posing significant challenges to disease control efforts. This study examines the prevalence of DR-TB in Iran from January 2000 to October 2023.

A comprehensive systematic search was conducted across multiple databases, including PubMed, Scopus, Google Scholar, EMBASE, BioMed Central, and Web of Science. The search utilized specific keywords such as "drug-resistant tuberculosis," "DR-TB," "MDR-TB," "XDR-TB," "Iran," "prevalence," and "risk factors," among others. Boolean operators (AND/OR) were employed to refine the search results. Only articles published between January 2000 and October 2023 were considered for inclusion. The search strategy followed the PRISMA guidelines, and the review questions were formulated based on the PICO model. The initial search identified 750 records. After removing duplicates and screening the titles, abstracts, and full texts, a total of 9 articles that met the inclusion criteria were included in the systematic review.

Between 2000 and 2023, the prevalence of MDR-TB in Iran ranged from 5.1 to 11.3% among general TB cases, increasing to 36% among retreatment cases and 18.5% in border provinces such as Sistan-Baluchestan. Retreatment patients had a sixfold higher risk of MDR-TB compared to new cases. Comorbidities such as diabetes (OR: 2.3) and HIV (OR: 3.1), along with male sex and older age, were significant contributing factors-particularly in XDR-TB cases. Despite the rising trend in drug resistance, diagnostic and laboratory limitations remain major challenges. Key risk factors include a history of previous treatment, diabetes mellitus, limited access to healthcare, and socioeconomic barriers. Diagnostic difficulties, including inadequate laboratory capacity and underutilization of molecular diagnostic tools, further complicate TB control and management.

Addressing the rising prevalence of DR-TB in Iran requires urgent public health interventions, including strengthening healthcare infrastructure, improving access to diagnostic services, and implementing community-based education programs to reduce stigma and enhance treatment adherence. Without these measures, the burden of DR-TB is likely to increase, further complicating efforts to control this public health crisis.