RISK FACTORS FOR DEVELOPMENT OF MULTIDRUG-RESISTANT TUBERCULOSIS AMONG RELAPSED PATIENTS IN WEST PAPUA, INDONESIA: A DESCRIPTIVE AND ANALYTICAL STUDY

Objective: Indonesia has one of the highest burdens of multidrug-resistant tuberculosis (MDR-TB), with 6800 new cases of MDR-TB annually and a previously reported cure rate of 51%. This study aimed to identify the risk factors that affect the development of MDR-TB in the diverse population of West Papua. Methods: A case–control study was conducted in Sorong Regency Regional Hospital, a referral center for MDR-TB in West Papua. Data were obtained from medical records of patients with relapsed TB between January 2014 and September 2017. Extracted data included demographic characteristics, family history, medication history (type of medication and duration), smoking history, supporting examinations (sputum test for acid-fast bacilli [AFB] and radiologist interpretation of thoracic X-ray), and comorbidities (HIV and diabetes mellitus). Results: Among 549 patients with suspected MDR-TB, 45 were confirmed to have MDR-TB. These 45 patients were defined as the case group and compared with a control group of 45 relapsed patients who had drug-sensitive TB. A great number of subjects in both case and control groups (44.4% and 57.8%) were categorized as previously lost to follow-up. Bivariate analysis using the chi-squared test found that an AFB result of+3 (odds ratio [OR]: 5.33, 95% confidence interval [CI] 1.76–16.09), diabetes mellitus (OR: 6.14, 95% CI 1.26–29.89), and completion of intensive-phase category I anti-TB therapy (OR: 3.25, 95% CI 1.04–10.07) were associated with MDR-TB. Conclusion: These clinical variables provide initial information about MDR-TB in West Papua and will assist clinicians to manage patients in related populations who have these risk factors