Background: Drug resistance to anti-tuberculosis drugs is a major public health problem that undermines successes in TB control. In Guinea-Bissau there were 25 MDR-TB patients in 2017 for an estimated treatment success rate of 44%. It is imperative to act at the grassroots level to prevent the emergence of such resistance, but no similar study has been carried out in the country. The objective of the study was to determine the factors associated with multidrug-resistant tuberculosis in Guinea-Bissau.
Methods: This unpaired case-control study included all multidrug-resistant tuberculosis (MDR-TB) cases and three controls for each case diagnosed between January 1, 2019 and December 31, 2019. We fitted an unconditional logistic regression model to determine the factors associated with MDR-TB.
Results: A total of 33 cases were included in the analysis. Prior treatment failure ORa = [14.93; 95% CI (5.22 - 42.64); p = 0.0001], knowledge of DOT strategy ORa= [5.23; 95% CI (2.14-12.80); p=0.0003], momentary interruption of treatment ORa= [5.26: 95% CI (1.88-14.75); p=0.0016] and failure to adhere medication times ORa = [0.18 95% CI (0.06-0.57); p=0.0033] were significantly associated with multidrug-resistant tuberculosis.
Conclusions: These results underline the need for adequate management of tuberculosis in Guinea-Bissau. The country would need substantial donor support to strengthen its diagnostic capacity for MDR-TB through the establishment of routine access to susceptibility testing and to strengthen its management capacity by subsidizing second-line drugs and training of medical specialists.

Multidrug-resistant tuberculosis; Associated factors; Guinea Bissau