Published in PLOS One on 2026-08-12, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. HealthSignal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Dorcas Kalaba, Chitalu Chanda, Muhammad Mputu, Hamooya M. Benson, Matenge Mutalange, Lukundo Siame, Sepiso K. Masenga, Webster Chewe, Kaziwe Sikambale, Kabaso Mwewa, Uchizi Chirwa, David Mukube Sitali, Claude Mumba, Kamilo Mununga, Nancy Chanda-Kasese, Namakando Liusha, Kabaso Mushota, Watson Mtonga, Patrick Lungu, Angel Mubanga, Eustarckio Kazonga, Nkomba Kayeyi
Source: PLOS One • DOI 10.1371/journal.pone.0355721
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Multidrug-resistant tuberculosis (MDR-TB) is a persistent public health challenge in Zambia, with favorable treatment outcomes remaining below the World Health Organization target of 90%. However, limited national evidence on treatment outcomes and their determinants hinders the development of effective programmatic responses. This study aimed to estimate the proportion of MDR-TB patients achieving favorable treatment outcomes and to identify factors independently associated with these outcomes in Zambia from 2018 to 2022.
A retrospective cross-sectional study was conducted using secondary data from the National Tuberculosis and Leprosy Programme Yathu database. All confirmed MDR-TB cases initiated on treatment across Zambia’s ten provinces from January 2018 to December 2022 were included. Demographic and clinical variables were extracted. Multivariable logistic regression was used to identify with factors independently associated with favorable treatment outcomes, reported as adjusted odds ratios (aORs) with 95% confidence intervals.
A total of 1,258 participants were included; the median age was 36 years (IQR: 28–44). Of these, 67.2% (n = 843) were male, while 53.0% (n = 662) were living with HIV. Overall, 68.1% (n = 857) achieved favorable treatment outcomes, while 31.9% (n = 401) had unfavorable outcomes. Normal body weight was positively associated with favorable outcomes (aOR 2.07; 95% CI: 1.02–4.21), while residing in Muchinga (aOR 0.12; 95% CI: 0.03–0.45; p = 0.002), and Western (aOR 0.17; 95% CI: 0.04–0.80; p = 0.024), was negatively associated with favorable outcomes.
Favourable MDR-TB treatment outcomes in Zambia is shaped by nutritional status and marked geographic disparities. Strengthening nutritional support and targeting provincial inequities are essential to improving treatment outcomes.
Introduction
Multidrug-resistant tuberculosis (MDR-TB), defined as resistance to at least isoniazid and rifampicin, the two most potent first-line anti-tuberculosis drugs, remains a critical threat to global public health [1]. In 2023, an estimated 410,000 new cases and 160,000 deaths were reported worldwide [2]. Globally, only 68% of MDR-TB patients achieve favorable treatment outcomes, falling well short of the 90% target established under the WHO End TB Strategy [2].
Sub-Saharan Africa bears a disproportionate share of this burden, accounting for approximately 25% of global MDR-TB cases. favorable treatment outcomes across the region remain persistently low, with studies from high-burden countries such as Ethiopia reporting outcomes well below global targets [3]. A systematic review and meta-analysis of MDR-TB and HIV co-infected patients across Sub-Saharan Africa similarly documented unfavorable and elevated mortality, underscoring the compounded challenge posed by the region’s dual epidemic of tuberculosis and HIV [4]. Zambia is classified by the WHO among the 30 high-burden countries for TB, HIV-associated TB, and MDR/RR-TB globally, a designation that reflects the severity of this dual epidemic within its borders [5]. Tuberculosis remains a leading cause of death among people living with HIV (PLHIV) in Zambia, driven by TB/HIV co-infection rates of 32% of all TB patients nationally [5]. Evidence from population-based analyses has further demonstrated that PLHIV in Zambia are significantly less likely to complete the TB care cascade compared to HIV-negative individuals, and that among those with rifampicin-resistant TB, only a fraction complete treatment, highlighting the urgent need for targeted interventions addressing both diseases simultaneously [6].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider public health desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Dorcas Kalaba, Chitalu Chanda, Muhammad Mputu, Hamooya M. Benson, Matenge Mutalange, Lukundo Siame, Sepiso K. Masenga, Webster Chewe, Kaziwe Sikambale, Kabaso Mwewa, Uchizi Chirwa, David Mukube Sitali, Claude Mumba, Kamilo Mununga, Nancy Chanda-Kasese, Namakando Liusha, Kabaso Mushota, Watson Mtonga, Patrick Lungu, Angel Mubanga, Eustarckio Kazonga, Nkomba Kayeyi. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by HealthSignal. The researchers are the authors of the source study, not members of HealthSignal’s staff.
Explore connected evidence
- Evidence brief: Predictors of tuberculosis mortality among patients on treatment: A retrospective cohort study at a rural general hospital in Zambia
- Evidence brief: Time to sputum culture conversion, treatment outcomes, and associated factors among rifampicin-resistant or multidrug-resistant tuberculosis patients in the Sidama region, Ethiopia: A retrospective follow-up study
- Evidence brief: Tertiary-care management of TB/HIV co-infection in Port Harcourt, Nigeria: A retrospective cohort analysis
