# Evaluating treatment outcomes stratified by regimen among drug-resistant TB patients in Sierra Leone

## TL;DR

This study compares the effectiveness of different treatment regimens for drug-resistant tuberculosis in Sierra Leone and finds that a specific regimen achieves better outcomes.

## Contribution

The study evaluates real-world treatment outcomes for drug-resistant TB patients and identifies regimen-specific success rates and predictors of failure.

## Key findings

- BPaL/BPaLM regimen had the highest treatment success rate (87.1%) compared to other regimens.
- HIV co-infection and underweight BMI independently predicted poor treatment outcomes.
- Propensity-weighted and sensitivity analyses confirmed the robustness of the findings.

## Abstract

Sierra Leone has a high burden of drug-resistant TB (DR-TB), managed at three treatment centres.

To compare treatment success between BPaL (bedaquiline, pretomanid, and linezolid)/BPaLM (bedaquiline, pretomanid, linezolid, and moxifloxacin) and the standardised short and the individualised long regimens among DR-TB patients and identify predictors of unsuccessful outcomes.

Retrospective cohort study utilising routinely collected national DR-TB data from January 2022 to December 2024.

Among 598 DR-TB patients registered from 2022 to 2024, 571 with complete outcomes were analysed. Overall treatment success was 80.2%, highest with BPaL/BPaLM (87.1%) compared with the standardised short (78.8%) and individualised long regimens (70.4%). Adjusted analyses showed BPaL/BPaLM remained strongly associated with higher success than the individualised long (adjusted risk ratio [aRR] 2.89; 95% confidence interval [CI] 1.80–4.64) and standardised short regimens (aRR 1.46; 95% CI 1.04–2.05). HIV co-infection and underweight body mass index independently predicted poor outcomes. Findings were consistent across propensity-weighted and sensitivity analyses.

Under routine programmatic conditions in Sierra Leone, BPaL/BPaLM achieved higher treatment success than standardised short or individualised long regimens. However, HIV co-infection and undernutrition predicted poorer outcomes, underscoring the need for integrated nutritional support, expanded drug-susceptibility testing, and strengthened TB/HIV services.