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Risk Factors for Incurable Drug-Resistant Tuberculosis: A Systematic Review

Karan Varshney, MPH, Beverly Anaele, MPH, Rosemary Frasso, PhD, MSc, MSc, CPH

Tuberculosis (TB) caused more deaths worldwide in 2018 than any other single infectious disease. In recent years, there has been an upsurge in cases of drug-resistant TB, and strains of TB resistant to all forms of treatment have begun to emerge. There is an urgent need to prevent TB that is completely resistant to treatment, and knowing the risk factors can inform prevention efforts. For the purpose of this systematic review, we identified and analyzed 25 articles, published since 2010, that examined relevant risk factors. We found that the most commonly reported risk for patients developing drug-resistant TB was having a history of TB. Other important risk factors were human immunodeficiency virus (HIV), a history of incarceration, low body mass, being a smoker, alcohol use, unemployment, being male, and being middle-aged. The findings show that adherence to treatment is crucial amongst TB patients, and that more efforts are needed to increase adherence rates in the population. HIV programs need to be scaled up in areas where both diseases are endemic. Efforts are also needed to raise awareness that smoking is a risk factor. More studies on risk factors for patients need to be conducted in India and Russia, where drug-resistant TB rates are highest. To our knowledge, this is the first systematic review to examine the risk factors for incurable drug-resistant TB.

Keywords: drug-resistant, tuberculosis, risk factors, compliance, adherence, XDR-TB,