Risk Factors for Poor Outcomes Among Patients with Extensively Drug-Resistant Tuberculosis (XDR-TB): A Scoping Review

Figures & data

Table 1 Search Terms by Category*

Population	OR	Individual	AND	Outcomes
“Risk Factors”[Mesh] OR “Sociological Factors”[Mesh] OR “Socioeconomic Factors”[Mesh] OR “Social Determinants of Health”[Mesh] OR “Epidemiologic Factors”[Mesh] OR “Biological Variation, Population”[Mesh] OR “Genetics, Population”[Mesh]		“Biological Variation, Individual”[Mesh] OR “Genetics, Behavioral”[Mesh] OR “Health Risk Behaviors”[Mesh] OR “Patient Compliance”[Mesh] OR “Medication Adherence”[Mesh] OR “HIV Infections”[Mesh] OR “Emigration and Immigration”[Mesh] OR “Poverty”[Mesh] OR “Guideline Adherence”[Mesh] OR “Disease Susceptibility”[Mesh] OR “Coinfection”[Mesh]		“Extensively Drug-Resistant Tuberculosis” OR “Extremely Drug-Resistant Tuberculosis” OR “Extensively Drug-Resistant Tuberculosis” OR “Extremely Drug-Resistant Tuberculosis” OR “Extra Extensively Drug-Resistant Tuberculosis” OR “Super Extensively Drug-Resistant Tuberculosis” “Totally Drug-Resistant Tuberculosis” OR “Total Drug-Resistant Tuberculosis” OR “Pan-Resistant Tuberculosis” OR “Pan Drug-Resistant Tuberculosis” OR “Pan Drug Resistant Tuberculosis” OR “Untreatable Tuberculosis” OR “Untreatable Drug-Resistant Tuberculosis” OR “Incurable Tuberculosis” OR “Incurable Drug-Resistant Tuberculosis” OR “XDRTB” OR “TDRTB” OR “XDR TB” OR “XXDR TB” OR “TDR TB” OR “XDR-TB” OR “XXDR-TB” OR “SXDR TB” OR “PDRTB” OR “PDR TB” OR “SXDR-TB” “SXDR TB” OR “SXDRTB”

Notes: *Mesh term used for PubMed, and its equivalent used for Scopus and ProQuest.

Figure 1 Study selection flow diagram.

Notes: PRISMAfigureadaptedfromPage MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71.CreativeCommons.²⁶

Table 2 Study, Region, and Participant Characteristics for Included Articles

Study	Country	Data Source	Study Design	Proportion of XDR Patients with Poor Outcomes (%)	XDR-TB Patients (% of Total)	Quality Score
Balabanova et al (2016)^Citation48	Latvia, Lithuania, Estonia, Romania	MDR and XDR TB patients at Lung Hospital at Tartu University (Estonia), National Tuberculosis and Infectious Diseases University Hospital in Vilnius (Lithuania), Clinic of Tuberculosis and Lung Diseases at Riga East University hospital (Riga, Latvia), and Marius Nasta Institute of Pneumology (Bucharest, Romania)	Prospective cohort study	227/737 (30.8%)*	81 (11.0%)	8/11
Balabanova et al (2011)^Citation49	Russia	Two separate cohorts from Samara with data from TB patients’ register, and chart reviews (only the second cohort was included for this review): 1)Non MDR-TB and MDR-TB patients in a pilot DOTS-programme, from the civilian and prison sectors 2)XDR-TB patients, all of whom were civilians	Prospective cohort study	53/92 (57.6%)	92 (100%)	7/11
Bei et al (2018)^Citation50	China	XDR-TB patients in 4 TB care centers across China (Changsha Central Hospital, Wuhan Treatment Center, the Third People’s Hospital of Hengyang, and the Second People’s Hospital of Chenzhou)	Prospective cohort study	20/67 (29.9%)	67 (100%)	7/11
Bhering, Duarte and Kritski (2019)^Citation51	Brazil	MDR and XDR-TB patients in Rio de Janeiro; data from Tuberculosis Surveillance System	Retrospective cohort study	1005/2269 (44.3%)*	140 (6.2%)	9/11
Blöndal et al (2012)^Citation52	Estonia	Tuberculosis patients across Estonia via the Tuberculosis Registry Database	Retrospective cohort study	82/211 (38.9%)	43 (20.4%)	10/11
Chingonzoh et al (2018)^Citation53	South Africa	Laboratory confirmed DR-TB patients of patients 18 years old and above across Eastern Cape Province; data from Electronic DR-TB Register (EDRWeb) by the South African National TB Programme	Retrospective cohort study	1445/3729 (38.8%)	763 (20.5%)	7/11
Frank et al (2019)^Citation54	Georgia	XDR-TB patients across Georgia; data from National TB program, medical charts, interviews, and national Georgian death registry	Retrospective cohort study	71/111 (67.0%)	111 (100%)	8/11
Gandhi et al (2012)^Citation55	South Africa	MDR and XDR-TB patients in from the district hospital Tugela Ferry, KwaZulu-Natal; data from medical records	Case-control study	189/262 (72.1%)	139 (53.1%)	8/10
Gandhi et al (2010b)^Citation56	South Africa	MDR and XDR-TB patients in Tugela Ferry, South Africa; data came from medical records	Retrospective cohort study	498/639 (77.9%)	374 (58.5%)	7/11
James et al (2011)^Citation57	India	MDR and XDR-TB suspected patients in a tertiary care hospital in Vellore, Tamil Nadu; data came from medical records	Retrospective cohort study	21/177 cases (11.9%)	45/177 (25.4%)	6/11
Javaid et al (2018)^Citation58	Pakistan	MDR and XDR-TB patients who received care the MDR-TB unit in Peshawar, Khyber Pakhtunkhwa province	Retrospective cohort study	129/535 (24.1%)*	26 (4.9%)	9/11
Kuksa et al (2014)^Citation59	Latvia	MDR and XDR-TB patients across Latvia; data from national TB registry	Retrospective cohort study	564/1779 (31.7%)	133 (6.7%)	10/11
Kvasnovsky et al (2011)^Citation60	South Africa	XDR-TB patients in hospitals of Eastern Cape Province, South Africa	Retrospective cohort study	95/206 (46.1%)	206 (100%)	10/11
Liu et al (2011)^Citation61	China	MDR and XDR-TB patients from the 309 hospital in Beijing	Retrospective cohort study	280/576 (48.6%)	48 (8.3%)	8/11
O’Donnell et al (2013)^Citation62	South Africa	Chart records from XDR patients admitted to a public TB referral hospital in KwaZulu-Natal	Retrospective cohort study	89/114 (78.1%)	114 (100%)	6/11
O’Donnell et al (2015)^Citation63	South Africa	Newly diagnosed adult XDR-TB patients in a public TB hospital in KwaZulu-Natal	Retrospective cohort study	49/216 (22.7%)	216 (100%)	8/11
Olayanju et al (2018)^Citation64	South Africa	Patients with laboratory-confirmed XDR-TB admitted to the Brooklyn Chest Hospital in Cape Town, Western Province	Prospective cohort study	168/272 (61.8%)	272 (100%)	9/11
Pietersen et al (2014)^Citation65	South Africa	XDR-TB patients from 3 XDR tuberculosis facilities: Brooklyn Chest Hospital (Cape Town, Western Cape), Gordonia Hospital (Upington, Northern Cape), Sizwe Tropical Diseases Hospital (Johannesburg, Gauteng Province)	Prospective cohort study	93/107 (86.9%)	107 (100%)	8/11
Pietersen et al (2015)^Citation66	South Africa	Case records of XDR-TB patients at two TB facilities in Western and Northern Cape Provinces	Retrospective cohort study	93/178 (52.2%)	178 (100%)	7/11
Shean et al (2013)^Citation67	South Africa	Case records of laboratory-confirmed XDR-TB patients across three XDR-TB treatment centers located in Gauteng, Northern Cape, and Western Cape	Retrospective cohort study	55/115 (47.8%)	55 (100%)	7/11
Shin et al (2010)^Citation68	Russia	Patients who began MDR-TB treatment at the Tomsk Oblast TB Treatment Services facility in Russia’s Western Siberia	Retrospective cohort study	210/608 (34.5%)	34 (5.6%)	7/11
Tang et al (2013)^Citation69	China	MDR and XDR-TB HIV-negative patients in 5 hospitals across China (Shanghai Pulmonary Hospital, Guangzhou Chest Hospital, Hangzhou Red Cross Hospital, Tianjin Haihe Hospital and Henan Infectious Hospital)	Retrospective cohort study	346/1662 (20.8%)*	169 (10.2%)	6/11
Te Riele et al (2019)^Citation70	South Africa	Patients with an XDR-TB diagnosis at the Brooklyn Chest Hospital in Cape Town	Prospective cohort study	86/97 (88.7%)	97 (100%)	8/11
Yuengling et al (2018)^Citation71	South Africa	Adult XDR-TB patients at a TB referral hospital in KwaZulu-Natal, South Africa	Prospective cohort study	72/105 (68.6%)	105 (100%)	10/11
Zhang et al (2018)^Citation72	China	MDR-TB and XDR-TB patients from six regions in Zhejiang province: Hangzhou, Huzhou, Jiaxing, Lishui, Quzhou, and Shaoxing	Prospective cohort study	148/537 (27.6%)*	19 (3.5%)	10/11

Notes: *Presented as MDR and XDR-TB patients with poor outcomes/Total MDR and XDR-TB patients if stratification for XDR-TB patients’ poor outcomes was not conducted in study.

Figure 2 Quality assessment score by study with the Joanna Briggs Institute’s Tools.

Table 3 Characteristics of Patients with XDR-TB and Having Poor Outcomes

Study	Country/City	XDR-TB Patients with PO/Total XDR-TB Patients* (%)	Males/Females	Ages in Years (Range)	Comorbidities	History of TB	Additional Features
Balabanova et al (2016)^Citation48	Estonia/Tartu, Lithuania/Vilnius, Latvia/Riga, Romania/Bucharest	227/737 (30.8%)*	195/32	15–29: 13 30–39: 37 40–49: 62 50–59: 72 60+: 43	HIV-positive: 10 Condition other than HIV: 22	Retreatment case: 148 92 had an unsuccessful treatment outcome in the past 56 had a successful treatment outcome in the past	149 resided in an urban setting 78 resided in a rural setting 173 were unemployed 152 were smokers 212 had only pulmonary (ie non extrapulmonary) TB 28 were smear positive at diagnosis 31 were not smear positive at diagnosis
Balabanova et al (2011)^Citation49	Russia/Samara	53/92 (57.6%)	Exact numbers not specified Female HR in comparison to males: 0.67, 95% CI: 0.37–1.22	Exact numbers not specified Greater than 40 years HR in comparison to those 40 and below: 1.01, 95% CI: 0.98–1.03	Exact numbers not specified HIV-positive HR in comparison to HIV-negative: 1.23, 95% CI: 0.49–3.11 Median survival time for HIV-positive patients was 185 days, compared to 496 days for HIV-negative patients	Exact numbers not specified Treatment history HR in comparison new patients: 1.54, 95% CI: 0.37–6.34
Bei et al (2018)^Citation50	China/Chuzhishi, Wuhan, Hengyan, Chenzhou	20/67 (29.9%)	Exact numbers not specified aHR for male sex (univariable analysis): 1.32, 95% CI: 0.44–3.96	Exact numbers not specified aHR for age>50 years: 2.40, 95% CI: 0.84–6.85	Cases combined with underlying diseases (exact numbers not specified) aHR: 3.48, 95% CI: 1.30–9.36	Exact numbers not specified: aHR for retreatment cases (univariable analysis): 0.43, 95% CI: 0.17–1.08	aHR for patients with BMI < 18.5 kg/m^2: 4.52, 95% CI: 1.31–15.65 aHR for patients with smoking history: 4.67, 95% CI: 1.66–3.16
Bhering, Duarte and Kritski (2019)^Citation51	Brazil/Rio de Janeiro (no particular city)	1005/2269 (44.3%) *	Exact numbers not specified Male univariable analysis aOR: 1.11 95% CI: 0.93–1.23 Male multivariable analysis aOR (for default only): 1.42, 95% CI: 1.08–1.87	Exact numbers not specified 40+ multivariable analysis aOR: 1.32, 95% CI: 1.06–1.66	Exact numbers not specified HIV positive multivariable analysis aOR: 1.60, 95% CI: 1.05–2.43 Diabetes multivariable analysis aOR: 0.72, 95% CI: 0.53–0.98 Other comorbidities multivariable analysis aOR (for default only): 0.39, 95% CI: 0.22–0.67 Other comorbidities multivariable analysis aOR (for death only): 2.03, 95% CI: 1.36–3.01	Exact numbers not specified Previous MDR-TB treatment multivariable analysis aOR: 2.35, 95% CI: 1.79–3.09	XDR-TB patients with poor outcomes multivariable analysis aOR (in comparison to MDR-TB patients): 4.71, 95% CI: 2.67–8.33 Afro-Brazilian patients with poor outcomes multivariable analysis aOR: 1.33, 95% CI: 1.05–1.67 Drug using patients with poor outcomes multivariable analysis aOR: 1.78, 95% CI: 1.15–2.75 Smoking patients with poor outcomes multivariable analysis aOR (default only): 1.66, 95% CI: 1.06–2.61 Individualized treatment regimen with poor outcomes (compared to standard regimen) univariable analysis aOR: 1.56, 95% CI: 1.31–1.86 Unemployed patients with poor outcomes univariable analysis aOR: 1.60, 95% CI: 1.28–2.00
Blöndal et al (2012)^Citation52	Estonia (no particular city)	20/43 (46.5%)	Exact numbers not specified. Male aHR: 3.61, 95% CI: 1.42–9.15	Not specified.	Not specified.	Exact numbers not specified. History of previous anti-tuberculosis treatment aHR: 3.96, 95% CI: 1.94–8.07	Birth outside of Estonia aHR: 1.91, 95% CI: 1.03–3.53 Second line drugs not stopped due to side effects aHR: 0.38, 95% CI: 0.16–0.90
Chingonzoh et al (2018)^Citation53	South Africa/Eastern Cape Province (city not specified)	463/763 (60.7%)	218/245	18–29: 125 30–44: 224 45–59: 103 60+: 11 Median (IQR): 36 (29–44)	HIV-positive: 324 HIV-positive and on ART treatment: 318 Compared to those who were HIV-negative, those coinfected with HIV and on ART had an aIRR of 1.1, 95% CI: 1.0–1.3, and those coinfected with HIV and not on ART had an aIRR of 1.8, 95% CI: 1.5–2.2	History of TB with 1st line drugs as treatment: 194 History of TB with 2nd line drugs as treatment: 209	376 initiated treatment at a DR-TB hospital 62 initiated treatment at a community level site
Frank et al (2019)^Citation54	Georgia (no particular city)	71/111 (67.0%)	56/15	Exact numbers not specified Median age: 39.0, IQR: 29.8–51.9	Hepatitis C Virus: 19 HIV-positive: 2 Diabetes mellitus: 6	41	38 patients with poor outcomes had reported tobacco use (OR for PO: 4.75, 95% CI 1.83–12.31) 32 patients with poor outcomes had reported alcohol use (OR for PO: 2.29, 95% CI: 0.95–5.49) 31 patients with poor outcomes had a history of incarceration (OR for poor outcomes: 8.27, 95% CI: 2.32–29.52)
Gandhi et al (2012)^Citation55	South Africa/Tugela Ferry	111/139 (79.9%)	54/57	Exact numbers not specified Median (IQR): 35 (29–43)	HIV-positive: 92	Previous TB treatment (any): 82	73 had a positive sputum smear (HR: 0.91, p=0.80) 20 (out of 92 HIV-positive) were on ART (HR for those HIV-positive and on ART: 0.34, p=0.009) 64 had been hospitalized within the last year (HR: 2.04, p=0.002) 17 patients with <50 CD4 cells/mm^3 (compared to those with > 200 CD4 cells/m^3, HR: 4.46, p=0.01) 22 patients with 51–200 CD4 cells/mm^3 (compared to those with > 200 CD4 cells/m^3, HR: 2.34, p=0.15)
Gandhi et al (2010b)^Citation56	South Africa/Tugela Ferry	310/374 (83%). Medical records only available for 139 XDR-TB patients	61/78	Median (IQR): 34 (29–42)	HIV-positive: 115 Receiving ARTs at time of TB diagnosis: 25 (22% of HIV positive)	Any previous TB treatment: 96 (69%) Previous TB treatment in the prior year: 78 (56%)	41 (30%) of XDR-TB patients had a presence of extrapulmonary TB Mortality was highest in the first 30 days after sputum collection. Median survival time after sputum collection for XDR-TB patients was 28.5 days, 95% CI, 20–34; P < 0.0001.
James et al (2011)^Citation57	India/Vellore	Not specified for XDR TB patients; 21/177 cases reported as resistant to all forms of available treatment (reported as XXDR-TB and TDR-TB – though these 2 terms were used interchangeably)	Exact numbers not specified	Exact numbers not specified	Out of 86 consenting to test for HIV, 0 had the virus	All (45; 100%) cases of XDR-TB and TDR TB had history of anti-TB drug use 12 (57.1%) of TDR TB cases had previously used second-line drugs. Mean duration of past anti-TB treatment for TDR TB cases (months): Mean: 25.38, SD: 25.73; p=0.770) TDR-TB cases had been given a mean of 4.10, SD: 3.87, p = 0.185 treatment regimens in the past	Smoking history was more common among those with non-resistant TB (40.0%) compared to those with DR TB (27.0%), with p=0.132
Javaid et al (2018)^Citation58	Pakistan/Peshawar	129/535 (24.1%)*	62/67	<18: 15 18–40: 69 41–60: 30 60+: 15	Comorbidities (any): 6	History of TB: 120 Previous use of second line drugs: 28	108 patients resided in a rural area 106 patients were married 17 patients were unemployed 23 patients were housewives
Kuksa et al (2014)^Citation59	Latvia (no particular city)	63/133 (47.4%)	48/15	< 18: 1 18–34: 18 35–54: 41 55+: 3	HIV-positive: 8	Retreatment after first treatment regimen: 12 Previous failure/default on MDR-TB treatment: 20 Relapse after MDR-TB treatment: 10	36 patients with alcohol abuse had PO: RR: 1.2, 95% CI: 0.9–1.4 46 patients that were smear-positive at the start of treatment had poor outcomes (RR: 1.9, 95% CI: 1.2–2.8) 23 patients with poor outcomeswere ex-prisoners (RR: 2.0, 95% CI: 1.4–2.7)
Kvasnovsky et al (2011)^Citation60	South Africa/ Eastern Cape Province (city not specified)	86/206 (41.8%)	Exact numbers not specified Male aOR: 1.2, 95% CI: 0.6–2.4 Comparison of HIV negative patients with HIV-positive patients not on HIV treatment: Male aOR: 1.1, 95%: 0.5–2.4	Exact numbers not specified <25 vs 25–42 years aOR: 3.5, 95% CI: 1.3–9.6 <25 vs >42 years old aOR: 2.2, 95% CI: 0.8–6.5 Comparison of HIV negative patients with HIV-positive patients not on HIV treatment: <25 vs 25–42 years aOR: 3.6, 95% CI: 1.2–10.3 <25 vs >42 years old aOR: 1.3, 95% CI: 0.4–3.8	Exact numbers not specified HIV status aOR: 1.2, 95% CI: 0.5–2.6 Comparison of HIV negative patients with HIV-positive patients not on HIV treatment: HIV status aOR: 2.5, 95% CI: 1.0–6.3	Exact numbers not specified Previous MDR-TB episode aOR: 1.3, 95% CI: 0.4–4.3 Comparison of HIV negative patients with HIV-positive patients not on HIV treatment: Previous MDRT TB episode aOR: 2.3, 95% CI: 0.6–8.7	65 XDR-TB diagnosed patients died before treatment Smear positive at treatment start aOR for patients with PO: 2.0, 95% CI: 1.0–4.1 Comparison of HIV negative patients with HIV-positive patients not on HIV treatment: Smear positive at treatment start aOR for patients with PO: 2.2, 95% CI: 1.0–5.0
Liu et al (2011)^Citation61	China/Beijing	34/48 (70.8%)	28/8	0–14: 1 15–29: 10 30–44: 13 45–59: 2 60–74: 6 75+: 2	Diabetes mellitus: 1 COPD: 8 Abnormal liver function: 8 Hepatitis: 1 Hypertension: 4	25	24 patients were migrants 31 patients with poor outcomes were reported to have resistance to more than 5 drugs 31 patients with poor outcomes had 4 or more years of TB disease 20 patients with poor outcomes not receiving 3 or more drugs, whereas only 2 survived (OR: 8.57, 95% CI: 1.65, 44.43) 28 patients with poor outcomes had smear-positivity at onset, whereas only 5 survived (OR: 6.72, 95% CI: 1.47, 30.76)
O’Donnell et al (2013)^Citation62	South Africa/KwaZulu-Natal	49/216 (22.7%)	16/33 Female aHR: 1.83, 95% CI: 0.96–3.49	Exact numbers not specified. Age aHR (per every 5 years): 1.18, 95% CI: 1.02–1.37	HIV-positive: 39 HIV-positive on ART: 24 HIV-positive aHR: 1.85, 95% CI: 0.65–5.26	History of TB treatment: 46 Does not have a history of TB treatment aHR: 0.97, 95% CI: 0.23–4.03	Capreomycin provided as treatment: 38. Capreomycin provided as treatment aHR: 1.68, 95% CI: 0.83–3.41
O’Donnell et al (2015)^Citation63	South Africa/KwaZulu-Natal	89/114 (78.1%) note: stratified data only available for 49 patients who died	22/27 Female aHR: 0.95, 95% CI: 0.51–1.77	<36: 25 36+: 24 <36 HR: 1.03, 95% CI: 0.59–1.80	HIV-positive: 36 HIV-positive aHR: 1.30, 95% CI: 0.61–2.78	History of TB treatment: 38 History of TB treatment aHR: 1.28, 95% CI: 0.45–3.65	Adverse event during treatment: 23 Adverse event during treatment HR: 1.02, 95% CI: 0.58–1.79
Olayanju et al (2018)^Citation64	South Africa/Cape Town	168/272 (61.8%)	Exact numbers not specified. Male aHR: 1.08, 95% CI: 0.76–1.52	Exact numbers not specified. Age HR: 1.00, 95% CI: 0.97, 1.03	Exact numbers not specified. HIV-positive aHR: 1.51, 95 CI: 1.06–2.15 HIV-positive on ART aHR: 1.31, 95% CI: 0.44–2.91	Exact numbers not specified. History of TB treatment (all patients) aHR: 1.08, 95% CI: 0.69–1.68 History of TB treatment (HIV-positive patients) aHR: 1.29, 95% CI: 0.65–2.54	Weight <50 kg aHR: 1.96, 95% CI: 1.38–2.78 Bedaquiline provided as treatment aHR: 0.14, 95% CI: 0.06, 0.30 Any aminoglycosides provided as treatment aHR: 4.10, 95% CI: 1.87, 8.97
Pietersen et al (2014)^Citation65	South Africa/Cape Town, Upington, Johannesburg	93/107 (86.9%)	Exact numbers not specified Male HR: 1.48, 95% CI: 0.58–3.78 Male HR among those HIV-positive: 0.76, 95% CI: 0.21–2.82	Exact numbers not specified Age at time of diagnosis HR: 0.99, 95% CI: 0.95–1.04 Age at time of diagnosis among those HIV-positive HR: 0.95, 95% CI: 0.89–1.01	Exact numbers not specified HIV infection HR: 1.48, 95% CI: 0.50–4.39	Exact numbers not specified Net sputum culture conversion ratio for those with no history of MDR-TB compared to those with a history of MDR-TB: 10.21, 95% CI: 2.64–39.38 Among those with HIV, no history of MDR-TB HR: 1.61, 95% CI: 0.37–6.96	1 reported case of totally drug-resistant tuberculosis Increased resistance was associated with Beijing genotype of disease (OR: 2.66, 95% CI: 1.18–17.35)
Pietersen et al (2015)^Citation66	South Africa/Northern and Western Cape Provinces (cities not specified)	93/178 (52.2%)	Not specified.	Not specified	HIV-positive OR: 2.90, 95% CI: 1.34–6.30	Not specified	Weight (kg) OR: 0.935, 95% CI: 0.902–0.969 Capreomycin rrs resistance (A1401G mutation) OR: 0.59, 95% CI: 0.21–1.65 Provision of Co-amoxicillin/clavulanic acid as treatment OR: 3.1, 95% CI: 1.4–6.6
Shean et al (2013)^Citation67	South Africa/Gauteng, Northern Cape, Western Cape (cities not specified)	55/115 (47.8%)	Not specified	Not specified	Not specified	Exact numbers not specified. History of MDR-TB aHR: 2.91, 95% CI: 1.16–7.35	Grade 3–5 adverse event aHR (note: reference is Grade 0–2 adverse event):1.43, 95% CI: 0.67–3.05 6 month culture conversion aHR: 0.10, 95% CI: 0.01–0.747
Shin et al (2010)^Citation68	Russia/Tomsk	29/34 (85.3%)	Exact numbers not specified. Male sex aHR: 0.37, 95% CI: 0.17–0.81	Exact numbers not specified. Age aHR: 1.01, 95% CI: 0.17–0.81	Exact numbers not specified. HIV-positive HR: 3.11, 95% CI: 0.43–22.71	Exact numbers not specified. Prior TB treatment with a second-line injectable aHR: 3.65, 95% CI: 1.81–7.37 Prior TB treatment with a quinolone HR: 3.31, 95% CI: 1.61–6.79	Started in TB hospital HR: 2.28, 95% CI: 1.11–4.68 Alcohol use during treatment HR: 1.58, 95% CI: 0.80–3.11 Baseline bilateral and cavitary lesions aHR: 3.47, 95% CI: 1.32–9.14
Tang et al (2013)^Citation69	China/Shanghai Guangzhou, Hangzhou, Tianjin, and Henan	346/1662 (20.8%)*	225/121	<45: 151 (43.6%) 45–65: 131 (37.9%) 65+: 64 (18.5%)	Diabetes: 65 COPD: 37 Chronic hepatitis: 30 Tumor: 10 Hepatic dysfunction: 39 Low albumin: 105	Retreatment case: 313 Duration of previous anti-TB treatment: <1 year: 83 1+ year: 263	147/169 of XDR-TB patients had PO (OR of poor outcomes for XDR-TB patients: 13.37, 95% CI: 6.75–26.50) 172 had a BMI of <18.5 174 had a BMI of 18.5+ (OR for poor outcomes: 2.19, 95% CI: 1.37–3.48) 77 (had the highest level of education as primary school 204 had the highest level of education as middle school 55 had the highest level of education as undergraduate 120 were peasants 135 were workers 91 had some other occupation
Te Riele et al (2019)^Citation70	South Africa/Cape Town	86/97 (88.7%) note: stratified data only available for 64 patients	40/24	Median (IQR): 35 (27–45)	Diabetes mellitus: 5 HIV-positive: 31	History of DR TB: 38	Median weight (kg) (IQR): 50 (44–58)
Yuengling et al (2018)^Citation71	South Africa/KwaZulu-Natal Province (city not specified)	72/105 (68.6%)	Exact numbers not specified Female aHR: 0.71, 95% CI: 0.38–1.34	Exact numbers not specified <36 aHR: 0.72, 95% CI: 0.37–1.38	HIV-positive: 46 HIV not on ART aHR (ref: HIV-negative): 4.68, 95% CI: 1.16–18.94 HIV on ART aHR (ref: HIV-negative): 1.59, 95% CI: 0.69–3.48	Any TB history aHR: 4.76, 95% CI: 0.65–34.95 History of MDR-TB treatment aHR (univariate analysis): 1.21, 95% CI: 0.65–2.24	An analysis of factors associated with favorable outcomes was conducted, and no other variables were found to be significantly associated with favorable outcomes
Zhang et al (2018)^Citation72	China/ Hangzhou, Huzhou, Jiaxing, Lishui, Quzhou, and Shaoxing	148/537 (27.6%)*	105/43	<30: 21 30–60: 80 >60: 47	Exact numbers not specified	Relapse patients: 60 Treatment after failure/default: 69 Other patients previously treated: 7 Previously treated with 1st line drugs only: 92 Previously treated with 2nd line drugs: 50	32 had individualized treatment 100 had standardized treatment 65 had adverse events during treatment 90 had unknown level of baseline resistance patterns 122 were not hospitalized prior to treatment 92 were farmers

Notes: *Presented as MDR and XDR-TB patients with poor outcomes/Total MDR and XDR-TB patients as stratification for XDR-TB patients’ poor outcomes was not conducted in study.

Abbreviations: TB, tuberculosis; DR-TB, drug-resistant tuberculosis; MDR-TB, multi-drug resistant tuberculosis; XDR-TB, extensively drug-resistant tuberculosis; pre-XDR-TB, pre-extensively drug-resistant tuberculosis; DS-TB, drug-susceptible tuberculosis; USD, United States dollar; HIV, human immunodeficiency virus; PRISMA-ScR, Preferred Items for Systematic Review and Meta-Analyses extension for Scoping Reviews; JBI, Joanna Briggs Institute; BMI, body mass index; ARTs, anti-retroviral therapies; DOT, directly observed therapy; EDRWeb, Electronic Drug-Resistant Tuberculosis Register; COPD, chronic obstructive pulmonary disease; OR, odds ratio; HR, hazard ratio; CI, confidence interval; aHR, adjusted hazard ratio; aOR, adjusted odds ratios; SD, standard deviation; kg, kilograms; IQR, interquartile range; ACF, active case finding; IPU, integrated practice units.

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