Rifampicin resistance among the TB Patients in Pakistan: a retrospective cross-sectional study

Rifampicin resistant (RR) tuberculosis (TB) is a key challenge in terms of high morbidity, mortality and socio-economic burden. Pakistan has the sixth highest RR TB prevalence globally. In the absence of a national TB survey during the past decade, this study was conducted to determine prevalence estimates.

This was a retrospective cross-sectional study (with an analytical component) of the bacteriologically confirmed TB patients whose sputum or other clinical samples were tested for RR (by Xpert® assay) in public-private mix (PPM) settings of 28 districts of Pakistan, from January 2022 to June 2024. Univariate and multivariable logistic regression analyses were performed for analysis.

Among the 42,423 patients with bacteriological confirmation by the Xpert, 231 (0.5%) had indeterminate result for RR. The RR TB prevalence was 2.31% among the valid results. Univariate analysis showed that RR TB was significantly associated with province, residence, age, sputum smear microscopy results, and history of TB treatment. Multivariate analysis of significant factors showed that RR TB was significantly associated with the province; Sindh (OR = 1.65) and Khyber-Pakhtunkhwa (OR = 0.51). Risk of RR TB was significantly lower among people above 60 years of age (OR = 0.59) and higher among people previously treated for TB disease (OR = 3.73).

Findings support the need for evidence-based strategies aimed at timely diagnosis and management of TB, with greater focus on people at risk of developing RR TB including patients living in RR TB prevalent provinces and among those previously treated for TB.