Primary Resistance to Anti-Tuberculosis Drugs: The Case of the Seven Health Regions in the Central African Republic

Abstract

Introduction: Resistance to anti-tuberculosis drugs poses a threat to tuberculosis control programs. The Central African Republic is no exception. The aim of this study is to determine the prevalence of primary tuberculosis resistance in the Central African Republic. Methodology: This study was conducted at the National Laboratory of Clinical Biology and Public Health and focused on tuberculosis data from the country’s seven health regions. The sample consisted of patients who tested positive for tuberculosis using GeneXpert. The data collected were entered into Excel and analyzed using Epi Info 7. Results: A total of 12,112 patients aged between 4 months and 100 years were registered between January and June 2025 in the country’s seven health regions. The median age was 35 ± 18 years and the most common age was 40 years. The most represented age group was 15 to 49 years. The male-to-female ratio was 1.28. The overall prevalence of primary tuberculosis resistance was 6.07%. The prevalence of single-drug resistant tuberculosis was 5.67% and that of multi-drug resistant tuberculosis was 0.41%. Resistance to rifampicin alone accounted for 93.10%. This primary resistance was predominant in the 15 - 49 age group. The highest prevalence of resistance was found in June with 48 cases, or 8.7%. Among the 2862 positive cases recorded, 174 cases of resistant tuberculosis were recorded, including 162 cases of resistance to first-line drugs and 12 cases of multidrug resistance. The highest prevalence of first-line resistance cases was found in the Bimbo health district with 11.8%, and cases of this resistance were most prevalent in Health Region No.7 of the country. Cases of primary resistance to anti-tuberculosis drugs were more common in sputum samples (93.67%) and in patients with a high bacterial load (33.33%). Month (p = 0.03), sex (0.03), place of residence (p = 0.04), pulmonary location (0.02), and bacterial load (0.01) were the variables significantly associated with resistance. The risk of developing resistant tuberculosis was 3.50 times higher in patients with pulmonary tuberculosis (adjusted OR = 3.50, CI = [1.07 - 8.15]). Conclusion: Measures focused on transmission and more specifically on the early detection of drug-resistant TB, the prevention of hospital acquired infections, contact tracing and the rapid provision of effective treatment are needed to better control primary resistance.