{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:00:33Z","timestamp":1790830833709,"version":"4.1.0"},"reference-count":0,"publisher":"International Union Against Tuberculosis and Lung Disease","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["int j tuberc lung dis"],"published-print":{"date-parts":[[2026,9,30]]},"abstract":"\n <sec><title>BACKGROUND<\/title>Multidrug-resistant TB (MDR-TB) threatens TB control in Bhutan. According to the 2017 national Drug Resistance Surveillance report of the Royal Centre for Disease Control, 13.7% of new pulmonary TB cases had rifampicin resistance,\n of whom 98% were also resistant to isoniazid. We investigated the factors associated with primary rifampicin-resistant\/multidrug-resistant TB (RR\/MDR-TB) among new pulmonary TB patients.<\/sec><sec><title>METHODS<\/title>We conducted a nationwide case-control\n study including 46 laboratory-confirmed primary RR\/MDR-TB cases and 138 drug-susceptible pulmonary TB controls (1:3 ratio). Multivariable logistic regression identified factors independently associated with primary RR\/MDR-TB.<\/sec><sec><title>RESULTS<\/title>Factors\n associated with primary RR\/MDR-TB were delay in diagnosis (adjusted odds ratio [AOR] 24.9,\n P<\/jats:italic>\n < 0.001), poor household ventilation (AOR 3.6,\n P<\/jats:italic>\n = 0.023), contact with MDR-TB patients (AOR 7.2,\n P<\/jats:italic>\n < 0.001), living alone (AOR 10.8,\n P<\/jats:italic>\n = 0.016), perceived health\n staff unfriendliness (AOR 9.6,\n P<\/jats:italic>\n = 0.004), and TB medicine unavailability (AOR 16.5,\n P<\/jats:italic>\n = 0.024). Increasing age was associated with lower odds of RR\/MDR-TB (AOR 0.94 per year,\n P<\/jats:italic>\n = 0.005).<\/sec><sec><title>CONCLUSION<\/title>Primary RR\/MDR-TB\n in Bhutan was strongly associated with delayed diagnosis, contact with known MDR-TB patients and modifiable health-system factors. Expanding rapid molecular testing, strengthening contact investigation, and improving patient-centred care are critical to interrupt transmission and sustain TB\n control gains.<\/sec>\n <\/jats:p>","DOI":"10.5588\/ijtld.26.0038","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T04:32:57Z","timestamp":1790829177000},"page":"448-453","source":"Crossref","is-referenced-by-count":0,"title":["Factors associated with primary rifampicin-resistant\/multidrug-resistant TB: a case-control study"],"prefix":"10.5588","volume":"30","author":[{"given":"T.","family":"Zangpo","sequence":"first","affiliation":[{"name":"Gidakom Hospital, National Medical Services, Ministry of Health, Thimphu, Bhutan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Norbu","sequence":"additional","affiliation":[{"name":"Medical Education Centre for Research, Innovation and Training, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Tenzin","sequence":"additional","affiliation":[{"name":"National TB Control Program, Department of Public Health, Ministry of Health, Thimphu, Bhutan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Nima","sequence":"additional","affiliation":[{"name":"Sir Charles Gairdner Hospital, Nedlands, WA, Australia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Dorji","sequence":"additional","affiliation":[{"name":"Gidakom Hospital, National Medical Services, Ministry of Health, Thimphu, Bhutan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.P.","family":"Dhakal","sequence":"additional","affiliation":[{"name":"Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Dorjee","sequence":"additional","affiliation":[{"name":"Khesar Gyalpo University of Health Sciences of Bhutan, Thimphu, Bhutan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Tsheten","sequence":"additional","affiliation":[{"name":"National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3554","container-title":["The International Journal of Tuberculosis and Lung Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ingentaconnect.com\/content\/iuatld\/ijtld\/2026\/00000030\/00000010\/art00004","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T04:33:09Z","timestamp":1790829189000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ingentaconnect.com\/content\/10.5588\/ijtld.26.0038"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":0,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,9,30]]}},"alternative-id":["1027-3719(20260930)30:10L.448;1-"],"URL":"https:\/\/doi.org\/10.5588\/ijtld.26.0038","relation":{},"ISSN":["1027-3719"],"issn-type":[{"value":"1027-3719","type":"print"}],"subject":[],"published":{"date-parts":[[2026,9,30]]}}}