Observational studyBMC infectious diseases2026
Rifampicin-resistant tuberculosis in Nangarhar, Afghanistan: prevalence and risk factors.
Observational study in BMC infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAfghanistan bears a high burden of tuberculosis (TB). Rifampin-resistant TB (RR-TB) poses a serious threat to disease control, and province-level data remain limited. This study aimed to identify associated risk factors and estimate the prevalence of Rifampin-Resistant TB among adult in Nangarhar Province.
methodsWe conducted an observational study with two components, facility based cross-sectional study to estimate the prevalence of rifampin-resistant TB, with a case–control analysis to evaluate associated risk factors, at three TB centers in Nangarhar province, from 1 September 2023 to 27 June 2024. A cross-sectional study estimated the prevalence of Rifampin-resistant TB among adults with Xpert-confirmed TB. A case–control analysis evaluated associated risk factors compared rifampicin-resistant TB cases with rifampicin-susceptible controls selected from the same centers. Eligibility and classification were determined by laboratory testing, including Xpert MTB/RIF, culture, and phenotypic drug susceptibility testing; clinical assessment and structured interviews were subsequently conducted. Multivariable logistic regression was used to identify independent risk factors for RR-TB.
resultsThe prevalence of rifampicin-resistant TB was 3.3% (67/2,038; 95% CI: 2.6–4.2). Prevalence was higher among previously treated patients than among new patients (30/273, 11.0%; 95% CI: 7.6–15.4 vs. 37/1,765, 2.1%; 95% CI: 1.5–2.8). Independent predictors of rifampicin resistance included prior TB treatment (aOR 4.0, 95% CI 1.5–10.7), household crowding (family size 5–10: aOR 5.1, 95% CI 2-12.6); sleeping density ≥ 4 persons/room: (aOR 20.8, 95% CI 2.67–162.8), TB exposure (any contact: aOR 15, 95% CI 3.2–69.6); exposure > 6 months: aOR 27.0, 95% CI 5-157), and smear positivity (aOR 2.5, 95% CI 1.2–5.15). Among the 60 RR TB cases with phenotypic results, 57/60 (95%) also had isoniazid resistance, and 10/60 (17%) had fluoroquinolone resistance.
conclusionRR-TB in Nangarhar is concentrated among retreatment patients and crowded households. The findings highlight the importance of universal rapid drug susceptibility testing, adherence support, and household-centred contact investigation in this setting.
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