OBJECTIVES: Multi-drug resistant TB has emerged a major threat to global TB control efforts with high reported cases in Ghana in recent times. However, limited epidemiological information to guide decision making in our context exist. This study aimed to determine factors associated with MDR-TB incidence to inform policy.

METHODS: We conducted 1:2 unmatched case-control study. MDR-TB case patient was MDR-TB client diagnosed by Culture and Drug Sensitivity Testing between January 2013 to December 2016 and alive at time of study. Control was susceptible TB client diagnosed January 2013-December 2016 who completed treatment, cured and alive at time of study. We interviewed participants on socio-demographic, treatment compliance, social support, Health system support and program protocol adherence exposures using digitized structured questionnaire on TBcare mobile app (Davies-Teye et all, 2016) and geospatially mapped residence of participants. Data collected was sent to an online platform from where excel template exported to STATA 13/SE was managed and multiple logistic regression analysis done.

RESULTS: The cumulative Incidence of MDR-TB in Greater Accra region, Ghana 2013 – 2016 was 1.4/100,000 population with Case fatality of 14.5%. Logistic regression analysis (95% confidence interval) showed clients previously treated for drug sensitive TB (AOR=308.52, CI 4.51 – 21097.65), interrupting CAT1 treatment ≤ 2months (AOR= 20.61, CI 1.50-283.19), defaulting CAT1 treatment > 2months (AOR=0.016, CI 0.0019-1.3333), previous treatment with only CAT1 medication (AOR=0.092, CI 0.0116-0.7384) and having end of treatment sputum testing (AOR=0.0582, CI 0.0107-0.3180) were associated with MDR-TB infection. However, males (OR=2.5, CI 0.811-8.612), loss of job (OR= 2.7, CI 1.07- 6.99) and receiving both CAT 1 & 2 medications (OR= 19.94, CI 4.01-99.26) only associated with bivariate analysis.

CONCLUSIONS: Contrary to school of thought that physician errors are main factors to MDR-TB development, this study showed patient non-compliance to medication as major factor to disease infection our setting.