High rates of death amongst people with multidrug resistant TB both during and beyond treatment in Sierra Leone, research shows 

A new study in Sierra Leone led by Liverpool School of Tropical Medicine has highlighted a high mortality rate among people with Multidrug-resistant tuberculosis (MDR-TB), including amongst those who had successfully completed treatment, showing how the disease continues to threaten efforts to end the global TB epidemic.  

The new research is the first national study of its kind in Africa to show mortality rates for people with MDR-TB following successful treatment, and to identify risk factors for adverse outcomes before, during, and beyond, treatment.  

The study, published in The Lancet Regional Health – Africa found that one in ten people with MDR-TB who successfully completed treatment and were followed up by the Sierra Leone National TB Programme, had died within the next 12 months. These deaths of people with MDR-TB were associated with a range of medical and social factors, including HIV, smoking and chronic lung disease.   

Of the 739 people with MDR-TB in Sierra Leone tracked over a two-year period, nearly one in five (18%) died before or during treatment. Deaths before or during treatment were linked to older age, unemployment, HIV, chronic lung and kidney disease, being underweight and other comorbidities.  

The research team argue that their findings indicate the burden of ill health caused by MDR-TB is likely to be substantially underestimated by data on treatment outcomes routinely reported by National TB Programmes and the World Health Organization (WHO). 

TB remains the biggest cause of death from a single infection globally, killing 1.25 million people in 2023. Approximately 400,000 people were estimated to have MDR-TB, defined as TB that is resistant to rifampicin and isoniazid, the two key frontline antibiotics against TB. While curable, treatment for MDR-TB takes longer, it can come with greater side effects and is associated with lower rates of cure than treatment for TB that is not resistant.   

Emerging evidence has suggested that people with TB, and especially MDR-TB, have a higher mortality rate than the general population even after apparent successful treatment. But until now, there has been limited evidence on the biomedical and social risk factors that underpin this phenomenon, which is in urgent need of being addressed.  

Dr Rashidatu Kamara, MD, PHD, public health expert and TB consultant, former LSTM Masters alumnus, and study co-author said: 

“Ending MDR-TB in Sierra Leone demands more than just effective drugs. It requires confronting the social and clinical realities that drive mortality. Our findings show that survival depends not only on treatment, but on integrated, person-centred care that addresses HIV, malnutrition, co-morbidities and socioeconomic vulnerability. If we are to change outcomes, our policies must transcend beyond curing TB to sustaining life before, during, and after treatment.”  

Faye Greenwood, a specialist HIV and infectious diseases pharmacist, former LSTM Masters alumnus, and co-author of the study said:   

‘Our results support expanding the definition of high quality MDR/RR-TB service delivery to incorporate care beyond the remit of active treatment. Whilst further research is needed to map effective health interventions, data gathered by the dedicated team in Sierra Leone enabled us to identify modifiable socioeconomic and health-related factors which can potentially be addressed to meaningfully improve an individual’s quality of life.’   

Tom Wingfield, Deputy Director of the Centre for TB Research at LSTM and co-senior author with Matthew Saunders of St George’s London, added “our findings demonstrate the critical need to develop and evaluate holistic, person-centred interventions to improve health and broader outcomes and reduce deaths among people with MDR-TB in Sierra Leone and beyond.” 

Read the article here: https://www.thelancet.com/journals/lanafr/article/PIIS3050-5011(26)00042-8/fulltext  

Read a related 2022 Lancet Global Health publication from the team here: https://pubmed.ncbi.nlm.nih.gov/35303463/