Drug-susceptible Tuberculosis Research Articles

Cost of inaction: a framework to estimate the economic cost of missing a patient with tuberculosis in the Indian context

ObjectivesTo estimate the economic impact of failure to find and treat tuberculosis disease and prevent tuberculosis infection from progressing to active disease.DesignEstimating the economic cost of not finding and treating...

Socio-economic burden of TB and its impact on child contacts in The Gambia.

To determine the social impact of adult TB on child household contacts living in the Greater Banjul Area, The Gambia. This was a prospective observational cohort study among adults (≥18 years) starting treatment for drug-susceptible pulmonary TB between June 2019 and July 2021 who reported having at least one child household contact. We collected data from 51 adults and 180 child contacts at the start of TB treatment (baseline) and again at 6 months of treatment. Participants were asked about expenses for school fees, healthcare, festivities and food security of child contacts. While school attendance of the child contacts remained largely unaffected, there was a significant drop in school performance at 6 months (P < 0.001). Furthermore, child contacts faced significant food insecurity in terms of food quantity and variety available, with up to a four-fold increase in some instances at 6 months compared to baseline (P < 0.001). Child contacts face a potential decline in school performance and risk of food insecurity. While a plethora of work is being undertaken to alleviate costs of care for TB patients, further emphasis is needed to ensure educational and social prosperity for child contacts, as adults with TB have socio-economic implications for the wider household.

Assessing patient satisfaction with video-supported therapy for drug-susceptible TB treatment.

Assessing patient satisfaction with video-supported therapy for drug-susceptible TB treatment.

Did Financial Social Support for Tuberculosis Patients Lead to Better Treatment Outcomes in Türkiye during 2018-2019?

This study examined which factors, including the regular financial social support program, influence tuberculosis (TB) treatment outcomes and success rates. Patients with TB registered during 2018-2019 were included in this retrospective cohort study. We classified them into 2 groups: those who received financial support for at least one month, and those who did not. Of the 22,867 sampled patients, 5,033 received financial social support and 17,834 did not. The success rate was 11.9% higher among patients who received financial social support than among those who did not (97.34% versus 85.40%). After controlling for other factors, the success rate among all patients was 1.3 times higher for female, 2.6 times higher for those under 50 years, 1.5 times higher for extra-pulmonary TB, 1.5 times higher for a new case, 5.9 times higher for drug susceptible TB, and 5.8 times higher for those who received financial support. Crucially, this is the first study from Türkiye evaluating the effect of a regular financial social support program on TB treatment outcomes since the program began in 2018. We recommend regular financial support for patients with TB in all countries.

1875. Factors associated with unfavorable tuberculosis treatment outcomes, Almaty, Kazakhstan, 2018-2021

Abstract Background The COVID-19 pandemic negatively influenced the availability of TB related services around the world, including detection, diagnosis and treatment. The purpose of this research is to assess the impact of the COVID-19 pandemic on TB treatment outcomes in Almaty, and to determine risk factors associated with said outcomes by examining data from before (2018-2019) and during the pandemic (2020-2021). Methods We conducted a retrospective cohort study among all people newly diagnosed with drug-sensitive tuberculosis over 18 years old who initiated treatment from 2018-2021 in Almaty. We abstracted data from the national tuberculosis electronic database. Unfavorable treatment outcomes were sorted as follows: ineffective treatment, death, loss for follow-up, results not evaluated, and transferred for treatment with second-line anti-TB drugs. We used multivariate Poisson regression to calculate adjusted relative risk [aRR] and 95% confidence intervals [95%CI]. Risk factors associated with TB treatment outcomes among people newly diagnosed with drug-susceptible TB, Almaty, Kazakhstan, 2018-2022 Results Among 1548 people newly diagnosed with TB during the study period, average age of was 43 years (range 18-93) and 52% were male. A higher proportion of people had unfavorable outcomes during the pandemic (2020-21) than before the pandemic (2018-19) (20% vs 11%, respectively, and aRR=1.8; CI: 1.4-2.2). Among those with unsuccessful outcomes, 1% were lost to follow-up, 3% had treatment failures, and 9% died. Risk factors for unfavorable TB treatment outcomes were: being male (aRR=1.4, 95%CI=1.1-1.8), having HIV (aRR=2.4, 95%CI=1.8-3.3), having drinking disorder (aRR=2.3, 95%CI=1.6-3.3) and experiencing homelessness (aRR=2.6, 95%CI=1.5-4.3) (Table 1). Protective factors for unfavorable TB treatment outcomes were: being 18-39 years old (aRR=0.4, 95%CI=0.3-0.6), 40-59 years old (aRR=0.6, 95%CI=0.4-0.8), and being student (aRR=0.1, 95%CI=0.02-0.9). Conclusion COVID-19 pandemic was associated with unfavorable treatment outcomes for people newly diagnosed with drug-sensitive tuberculosis in Almaty, Kazakhstan. People with lower social stability were at increased risk. Results point to the need for improved continuity of care for TB treatment for people at increased risk of unfavorable outcomes, especially during disease outbreaks and pandemics. Disclosures All Authors: No reported disclosures

1255. Filipino Health Care Professionals’ Knowledge, Attitude and Perception regarding Drug-Susceptible and Drug-Resistant Tuberculosis in a High TB Burden City in Central Luzon: A Cross- Sectional Study

Abstract Background Tuberculosis (TB) is one of the major diseases responsible for the public health and economic crisis in low-income countries, with the Philippines as one of the eight countries in 2020 that accounted for two thirds of the new TB cases worldwide. Its three most populous regions which are the National Capital Region, Calabarzon and the Central Luzon Region reported the highest number of TB cases in 2015. One important consideration is that health care providers’ knowledge, attitude and perception regarding TB largely affects the success of TB treatment. Methods This study assessed the knowledge, attitude and perception among health care professionals who manage tuberculosis, using a validated questionnaire regarding drug-susceptible and drug-resistant tuberculosis in Cabanatuan City, Nueva Ecija. Cross-sectional study was used in this research. All health care professionals assigned in each identified health facility were asked to participate in the study. After obtaining informed consent, a self-administered questionnaire was given to all participants to answer. Descriptive statistics and Chi-square tests were used in data analysis. Figure 1 Selection of Study Participants through Purposive Sampling Results Table 1 Socio-Demographic Profile of HCPs in Cabanatuan City Nueva Ecija Table 2 Knowledge of HCPs on Diagnosis and Nature of Tuberculosis Table 3 Attitude of HCPs towards Patients with Tuberculosis and the TB Control Systems Conclusion The lack of training may have largely contributed to the poor knowledge of HCPs which may possibly hinder the success of providing TB treatment. It is therefore a paramount consideration that prior to the HCP’s assignment in TB DOTS centers, all HCPs must first undergo training in order to manage TB treatment properly and successfully. Table 4 Perception of HCPs towards Tuberculosis Table 5.1 Significant Difference between overall TB Knowledge of HCPs and the Socio-Demographic Profile Table 5.2 Significant Difference between MDR-TB Knowledge of HCPs and the Socio-Demographic Profile Disclosures All Authors: No reported disclosures

Cost of digital technologies and family-observed DOT for a shorter MDR-TB regimen: a modelling study in Ethiopia, India and Uganda

BackgroundIn 2017, the WHO recommended the use of digital technologies, such as medication monitors and video observed treatment (VOT), for directly observed treatment (DOT) of drug-susceptible TB. The WHO’s 2020 guidelines extended these recommendations to multidrug-resistant tuberculosis (MDR-TB), based on low evidence. The impact of COVID on health systems and patients underscored the need to use digital technologies in the management of MDR-TB.MethodsA decision-tree model was developed to explore the costs of several potential DOT alternatives: VOT, 99DOTS (Directly-observed Treatment, Short-course) and family-observed DOT. Assuming a 9-month, all-oral regimen (as evaluated within the STREAM trial), we constructed base-case cost models for the standard-of-care DOTs in Ethiopia, India, and Uganda, as well as for the three alternative DOT approaches. The models were populated with STREAM Stage 2 clinical trial outcome and cost data, supplemented with market prices data for the digital DOT strategies. Sensitivity analyses were conducted on key parameters.ResultsModelling suggested that the standard-of-care DOT approach is the most expensive DOT strategy from a societal perspective in all three countries evaluated (Ethiopia, India, Uganda), with considerable direct- and indirect-costs incurred by patients. The second most expensive DOT approach is VOT, with high health-system costs, largely caused by up-front technology expenditure.Each of VOT, 99DOTS and family-observed DOT would reduce by more than 90% patients’ direct and indirect costs compared to standard of care DOT.Results were robust to the sensitivity analyses.ConclusionsWhile data on the costs and efficacy of alternative DOT approaches in the context of shorter MDR-TB treatment is limited, our modelling suggests alternative DOT approaches can significantly reduce patient costs in all three countries. Health system costs are higher for VOT and lower for 99DOTS and family-observed therapy when compared to standard of care DOT, as low smartphone penetration and internet availability requires the VOT health system to fund the cost of making them available to patients.

Impact of COVID-19 on selected essential public health services – lessons learned from a retrospective record review in the Free State, South Africa

BackgroundIn an attempt to discern lessons to improve future pandemic responses, this study measured the effects of the COVID-19 pandemic on essential public health services (EPHSs) related to primary health care (PHC) and outpatient department (OPD) utilisation, antiretroviral treatment (ART) commencement, drug-susceptible tuberculosis (DS-TB) confirmation and treatment commencement, and Bacillus Calmette-Guérin (BCG) coverage, in the Free State province of South Africa during January 2019 to March 2021.MethodsA pre-post study design comparing EPHS performance between 2019 and 2020/21 was employed. Routinely collected data were analysed. An interrupted time series analysis was used to measure changes in service use and outcomes from January 2019 to March 2021. Median changes were compared using Wilcoxon rank-sum tests. A 5% statistical significance level was considered.ResultsOver the study period, the median values for the annual number of PHC visits was 1.80, 55.30% for non-referred OPD visits, 69.40% for ART commencement, 95.10% and 18.70% for DS-TB confirmation and treatment commencement respectively, and 93.70% for BCG coverage. While BCG coverage increased by 5.85% (p = 0.010), significant declines were observed in PHC utilisation (10.53%; p = 0.001), non-referred OPD visits (12.05%; p < 0.001), and ART commencement (9.53%; p = 0.017) rates. Given the importance of PHC in addressing a new pandemic, along with the existing HIV and TB epidemics – as well as the entire quadruple burden of disease – in South Africa, the finding that the PHC utilisation rate statistically significantly decreased in the Free State post-COVID-19 commencement is particularly concerning.ConclusionsThe lessons learned from this retrospective review attest to a measure of resilience in EPHS delivery in the Free State in as far as a significant hike in BCG vaccination over the study period, 2019–2020/21 was observed. As evidenced by a decline in PHC service utilisation and the decreased numbers of new patients commencing ART, we also learned that EPHS delivery in the province was fragile.

Real-world impact of the fixed-dose combination on improving treatment outcomes of drug-susceptible tuberculosis: a comparative study using multiyear national tuberculosis patient data

BackgroundThe fixed-dose combination (FDC) for first-line antituberculosis (TB) treatment has long been a standard practice worldwide; however, there is limited evidence on whether the use of FDC improves long-term treatment...

Pharmacokinetics and safety of first-line tuberculosis drugs rifampin, isoniazid, ethambutol, and pyrazinamide during pregnancy and postpartum: results from IMPAACT P1026s.

Physiological changes during pregnancy may alter the pharmacokinetics (PK) of antituberculosis drugs. The International Maternal Pediatric Adolescent AIDS Clinical Trials Network P1026s was a multicenter, phase IV, observational, prospective PK and safety study of antiretroviral and antituberculosis drugs administered as part of clinical care in pregnant persons living with and without HIV. We assessed the effects of pregnancy on rifampin, isoniazid, ethambutol, and pyrazinamide PK in pregnant and postpartum (PP) persons without HIV treated for drug-susceptible tuberculosis disease. Daily antituberculosis treatment was prescribed following World Health Organization-recommended weight-band dosing guidelines. Steady-state 12-hour PK profiles of rifampin, isoniazid, ethambutol, and pyrazinamide were performed during second trimester (2T), third trimester (3T), and 2-8 of weeks PP. PK parameters were characterized using noncompartmental analysis, and comparisons were made using geometric mean ratios (GMRs) with 90% confidence intervals (CI). Twenty-seven participants were included: 11 African, 9 Asian, 3 Hispanic, and 4 mixed descent. PK data were available for 17, 21, and 14 participants in 2T, 3T, and PP, respectively. Rifampin and pyrazinamide AUC0-24 and C max in pregnancy were comparable to PP with the GMR between 0.80 and 1.25. Compared to PP, isoniazid AUC0-24 was 25% lower and C max was 23% lower in 3T. Ethambutol AUC0-24 was 39% lower in 3T but limited by a low PP sample size. In summary, isoniazid and ethambutol concentrations were lower during pregnancy compared to PP concentrations, while rifampin and pyrazinamide concentrations were similar. However, the median AUC0-24 for rifampin, isoniazid, and pyrazinamide met the therapeutic targets. The clinical impact of lower isoniazid and ethambutol exposure during pregnancy needs to be determined.

Treatment success and related factors of drug-susceptible and drug-resistant tuberculosis patients in Aceh referral hospital

Background: Tuberculosis (TB) remains one of the top ten causes of mortality worldwide. It is caused by a single infectious agent, Mycobacterium tuberculosis. Indonesia has the second highest cases globally and has a high burden of rifampicin-resistant (RR-TB). Xpert MTB/RIF has been used as a frontline test to detect RR-TB to improve treatment efficacy. Objective: This study aims to summarise the bacteriologic conversion rate as the patient’s cured hallmark and related factors among adults confirmed to have pulmonary tuberculosis in a referral hospital in Aceh Province. Method: The authors assessed 1,244 bacteriologic test results of sputum samples from TB presumptive patients from January 1st to December 31st 2018, in the Clinical Microbiology Laboratory and evaluated bacteriologic conversion. Result: There were 361 bacteriologic-confirmed TB diagnoses, where 43 (11.9%) were RR-TB. Most TB patients (26.3%) were in close contact with active TB patients. Conclusion: The study showed TB patients' low follow-up rate and bacteriologic conversion. The high prevalence of TB among close contacts suggests a need for constant surveillance of this high-risk group to end the TB epidemic. Male, young adult, and Aceh Besar residents have observed factors in sputum conversion results.

Community-supported self-administered tuberculosis treatment combined with active tuberculosis screening: a pilot experience in Conakry, Guinea

ABSTRACT Directly observed treatment (DOT) for tuberculosis (TB) is recommended by the World Health Organization. However, DOT does not always meet patients’ preferences, burdens health facilities, and is hard to implement in settings where access to healthcare services is regularly interrupted. A model addressing these limitations of DOT is community-supported self-administered treatment (CS-SAT), in which patients who self-administer TB treatment receive regular visits from community members. Guinea is a country with a high TB burden, recurrent epidemics, and periodic socio-political unrest. We piloted a CS-SAT model for drug-susceptible TB patients in Conakry, led by community volunteers, who also conducted active TB case finding among household contacts and referrals for isoniazid preventive treatment (IPT) in children below 5 years old. We aimed to assess TB treatment outcomes of patients on CS-SAT and describe the number of patients identified with TB case finding and IPT provision. Prospectively enrolled bacteriologically confirmed TB patients, presenting to two facilities, received monthly TB medication. Community volunteers performed bi-weekly (initiation phase) and later monthly (continuation phase) home visits to verify treatment adherence, screen household contacts for TB, and assess IPT uptake in children under five. Among 359 enrolled TB patients, 237 (66.0%) were male, and 37 (10.3%) were HIV-positive. Three hundred forty (94.7%) participants had treatment success, seven (1.9%) died, seven (1.9%) experienced treatment failure, and five (1.4%) were lost-to-follow-up. Among 1585 household contacts screened for TB, 26 (1.6%) had TB symptoms, of whom five (19.2%) were diagnosed with pulmonary TB. IPT referral was done for 376 children from 198 households. In a challenging setting, where DOT is often not feasible, CS-SAT led to successful TB treatment outcomes and created an opportunity for active TB case finding and IPT referral. We recommend the Guinean CS-SAT model for implementation in similar settings.

Isoniazid and rifampicin exposure during treatment in drug-susceptible TB.

BACKGROUND: Observational real-world studies on therapeutic drug monitoring (TDM) in relation to pharmacokinetic (PK) target values are lacking. This study aims to describe the PK of rifampicin (RIF) and isoniazid (INH) in a real-world setting of patients with drug-susceptible TB in relation to frequently used threshold values.METHODS: A total of 116 patients with TB using standard doses of RIF and INH and who had TDM as part of clinical care were included. Maximum plasma concentration (Cmax) and 24 h area under the concentration time curve (AUC24) at standard and revised doses were described in relation to the threshold values (Cmax ≥8 mg/L for RIF and ≥3 mg/L for INH).RESULTS: For RIF (100 patients), median Cmax and median AUC24 were respectively 7.9 mg/L (IQR 6.0-11.0) and 35.8 mg*h/L (IQR 27.4-57.3) at the first TDM measurement after a standard dose of 600 mg. For INH (90 patients), median Cmax and median AUC24 were respectively 2.9 mg/L (IQR 1.3-2.5) and 12.5 mg*h/L (IQR 8.7-18.9) at the first TDM after a standard dose 300 mg. Overall, more than 50% of study participants had drug exposure below threshold values at the first TDM.CONCLUSION: Our study shows that the measured Cmax values for both RIF and INH were frequently below the pre-specified targets, emphasising the need for better justification of drug exposure targets. These TDM results highlight the need for validating PK targets of anti-TB drugs associated with clinically relevant outcomes.

Estimated Costs of 4-Month Pulmonary Tuberculosis Treatment Regimen, United States.

We estimated direct costs of a 4-month or 6-month regimen for drug-susceptible pulmonary tuberculosis treatment in the United States. Costs were $23,000 per person treated. Actual treatment costs will vary depending on examination and medication charges, as well as expenses associated with directly observed therapy.

Cost-Effectiveness Analysis of the Optimal Control Strategies for Multidrug-Resistant Tuberculosis Transmission in Ethiopia

Despite the recent progress of global control efforts, tuberculosis (TB) remains a significant public health threat worldwide, especially in developing countries, including Ethiopia. Furthermore, the emergence of multidrug-resistant tuberculosis (MDR-TB) has further complicated the situation. This study aims at identifying the most effective strategies for combating MDR-TB in Ethiopia. We first present a compartmental model of MDR-TB transmission dynamics in Ethiopia. The model is shown to have positive solutions, and the stability of the equilibrium points is analyzed. Then, we extend the model by incorporating time-dependent control variables. These control variables are vaccination, distancing, and treatment for DS-TB and MDR-TB. Finally, the optimality system is numerically simulated by considering different combinations of the strategies, and their cost effectiveness is analysed. Our finding shows that, among single control strategies, the successful treatment of drug-susceptible tuberculosis (DS-TB) is the most effective control factor for eliminating MDR-TB transmission in Ethiopia. Furthermore, within the six dual control strategies, the combination of distancing and successful treatment of DS-TB is less costly and more effective than other strategies. Finally, out of the triple control strategies, the combination of distancing, successful treatment for DS-TB, and treatment for MDR-TB is the most efficient strategy for curbing the MDR-TB disease in Ethiopia. Thus, to reduce MDR-TB efficiently, it is recommended that authorities focus on treating MDR-TB, effective treatment of DS-TB, and promoting social distancing through public health education and awareness programs.

A descriptive study of new drug approvals during 2017-2021 and disease morbidity and mortality patterns in India.

Studies show the presence of a mismatch between drug research and disease burden. A study conducted in the European Union found that new drug development was restricted to certain diseases. A study of biosimilar approvals in India found that 87% of drugs were for treating noncommunicable diseases. This study aimed to determine the new drugs approved in India from 2017 to 2021 and the top ten causes of morbidity and mortality and detect the presence of any discordance between these. A descriptive study was conducted using data on new drug approvals accessed from the Central Drugs Standard Control Organization website. The top ten causes of mortality and morbidity in India from 2015 to 2019 were identified from the Global Burden of Diseases database. Descriptive statistics were used to compare the drug approvals and the leading diseases. One hundred twenty-six drugs were approved during the study period. Antineoplastic drugs constituted 19.84% of the approvals, antimicrobials 18.25%, and cardiovascular drugs 9.52%. Ischemic heart disease and chronic obstructive pulmonary disease were the two leading causes of morbidity and mortality. Diarrheal diseases, lower respiratory tract infection, and drug-susceptible tuberculosis were among the top ten causes. Ten antibacterials, including four antitubercular drugs, were approved during this period. Two drugs were approved for rare diseases. Our study showed that the drugs approved were largely in line with the prevalent disease burden, and there was no significant discordance observed. Some diseases, such as ischemic stroke/intracranial hemorrhage, require further efforts in bringing forth newer pharmacotherapy options.

Investigation of genomic mutations and their association with phenotypic resistance to new and repurposed drugs in Mycobacterium tuberculosis complex clinical isolates.

WGS has the potential to detect resistance-associated mutations and guide treatment of MDR TB. However, the knowledge base to confidently interpret mutations associated with the new and repurposed drugs is sparse, and phenotypic drug susceptibility testing is required to detect resistance. We screened 900 Mycobacterium tuberculosis complex genomes from Ireland, a low TB incidence country, for mutations in 13 candidate genes and assessed their association with phenotypic resistance to bedaquiline, clofazimine, linezolid, delamanid and pretomanid. We identified a large diversity of mutations in the candidate genes of 195 clinical isolates, with very few isolates associated with phenotypic resistance to bedaquiline (n = 4), delamanid (n = 4) and pretomanid (n = 2). We identified bedaquiline resistance among two drug-susceptible TB isolates that harboured mutations in Rv0678. Bedaquiline resistance was also identified in two MDR-TB isolates harbouring Met146Thr in Rv0678, which dated back to 2007, prior to the introduction of bedaquiline. High-level delamanid resistance was observed in two isolates with deletions in ddn, which were also resistant to pretomanid. Delamanid resistance was detected in two further isolates that harboured mutations in fbiA, but did not show cross-resistance to pretomanid. All isolates were susceptible to linezolid and clofazimine, and no mutations found were associated with resistance. More studies that correlate genotypic and phenotypic drug susceptibility data are needed to increase the knowledge base of mutations associated with resistance, in particular for pretomanid. Overall, this study contributes to the development of future mutation catalogues for M. tuberculosis complex isolates.

Shorter TB treatment regimens should be safer as well.

Most ongoing and planned TB therapeutic trials are focused on shortening the duration of treatment while giving less consideration to other aspects of TB care that are important to people with TB. Here we argue that other variables besides duration of TB treatment should also be considered when developing new TB treatment regimens, including drug toxicity, time spent in monitoring and overall quality of life while on therapy. We examine the specific use of linezolid in treatment-shortening trials for drug-susceptible TB and propose additional endpoints that should be prioritised in TB treatment studies.

Transforming growth factor-β, Interleukin-23 and interleukin-1β modulate TH22 response during active multidrug-resistant tuberculosis.

We previously reported that patients with multidrug-resistant tuberculosis (MDR-TB) showed low systemic and Mtb-induced Th22 responses associated to high sputum bacillary load and severe lung lesions suggesting that Th22 response could influence the ability of these patients to control bacillary growth and tissue damage. In MDR-TB patients, the percentage of IL-22+ cells inversely correlates with the proportion of senescent PD-1+ T cells. Herein, we aimed to evaluate the pathways involved on the regulation of systemic and Mtb-induced Th22 response in MDR-TB and fully drug-susceptible TB patients (S-TB) and healthy donors. Our results show that while IL-1β and IL-23 promote Mtb-induced IL-22 secretion and expansion of IL-22+ cells, TGF-β inhibits this response. Systemic and in vitro Mtb-induced Th22 response inversely correlates with TGF-β amounts in plasma and in PBMC cultures respectively. The number of circulating PD-1+ T cells directly correlates with plasmatic TGF-β levels and blockade of PD-1/PD-L1 signalling enhances in vitro Mtb-induced expansion of IL-22+ cells. Thus, TGF-β could also inhibit Th22 response through upregulation of PD-1 expression in T cells. Higher percentage of IL-23+ monocytes was observed in TB patients. In contrast, the proportion of IL-1β+ monocytes was lower in TB patients with bilateral lung cavities (BCC) compared to those patients with unilateral cavities (UCC). Interestingly, TB patients with BCC showed higher plasmatic and Mtb-induced TGF-β secretion than patients with UCC. Thus, high TGF-β secretion and subtle differences in IL-23 and IL-1β expression could diminish systemic and in vitro Mtb-induced Th22 response along disease progression in TB patients.

Assessment of drug-susceptible and multidrug-resistant tuberculosis (MDR-TB) in the Central Region of Somalia: A 3-year retrospective study.

Multidrug-resistant tuberculosis (MDR-TB) remains a public health emergency and a threat globally. Although increasing MDR-TB cases have been recently reported in Somalia, limited information is known. This study aims to determine the prevalence of drug-susceptible and MDR-TB in suspected patients referred to the TB Department in Mudug Hospital, Galkayo, Somalia, and identify potential factors associated with MDR-TB. A 3-year hospital laboratory-based retrospective study was conducted by manually reviewing laboratory records of Mycobacterium tuberculosis specimens and GeneXpert MTB/RIF results from January 2019 to December 2021 at the reference mycobacteria laboratory department in Mudug Hospital. A total of 714 positive GeneXpert-MTB results were identified: 619 (86.7%) were drug susceptible (no Rifampin resistance [RR] detected) and 95 (13.3%) with RR detected or defined as MDR-TB. Most of the MDR-TB patients were males (71.6%, 68/95) and between the ages of 15 to 24 (31.6%, 30/95). Most isolates were collected in 2021 (43.2%, 41/95). Multivariate analyses show no significant difference between patients having MDR-TB and/or drug-susceptible TB for all variables. This study showed an alarming frequency of MDR-TB cases among M. tuberculosis-positive patients at a regional TB reference laboratory in central Somalia.