Abstract
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.
Highlights
The magnitude of the global problem of tuberculosis (TB) disease is relatively high but differs around the world
Nine subjects from the case group (20%) had family who had been diagnosed with TB and one subject (1.1%) had extrapulmonary TB
This study provides the first description of TB patients, especially those with multidrug-resistant TB (MDR-TB), in the region of West Papua, Indonesia
Summary
The magnitude of the global problem of tuberculosis (TB) disease is relatively high but differs around the world. According to the latest World Health Organization (WHO) global report in 2017, 10.4 million people were estimated to be ill from TB, with an estimated 1.3 million deaths among HIV-negative TB patients and an additional 374,000 deaths among HIV-positive TB patients. Global WHO surveillance in 2017 reported 490,000 cases of multidrug-resistant TB (MDR-TB) and 110,000 cases of rifampicin-resistant TB (RR-TB) in 2016. From another perspective, cases of MDR-TB represent 4.1% of newly diagnosed cases and 19% of cases of relapsed previously treated TB [1,2,3,4]
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