The findings from the sixth national Prevalence Drug-Resistant Tuberculosis Survey in Nepal, 2024

Introduction: Tuberculosis remains a major public health challenge in Nepal, with rising drug-resistant TB and limited surveillance capacity. To address this gap, we conducted the sixth national drug-resistant TB prevalence survey to estimate DR-TB burden and risk factors among new and previously treated pulmonary TB patients. Methods: We conducted a national cross-sectional survey from December 2022 to January 2024, enrolling bacteriologically confirmed pulmonary TB patients using stratified cluster sampling from 49 diagnostic centers. Phenotypic and genotypic DST was performed on 1,768 Mycobacterium tuberculosis–confirmed samples, and logistic regression was used to estimate DR-TB prevalence and associated risk factors. Results: Rifampicin resistance was 2.2% (95% CI: 1.4–3.6) among new TB patients and 10.1% (95% CI: 5.1–19) among previously treated patients. Overall, 9.4% had resistance to at least one first-line drug, with isoniazid showing the highest resistance. Fluoroquinolone resistance was higher among new RR-TB patients, and previous TB treatment was the strongest predictor of rifampicin resistance (aOR: 4.1; 95% CI: 2.6–6.4). Conclusion: Nepal’s RR/MDR-TB prevalence remains stable compared with previous surveys; however, high fluoroquinolone resistance among new patients underscores the need for improved antibiotic stewardship and expanded DST services. These findings provide essential evidence to inform national TB control strategies.