<p>Characteristics of study participants.</p>

Multivariable logistic regression was used to identify factors independently associated with rifampicin resistance.</p><p>A total of 6,897 GeneXpert MTB/RIF tests were included. The mean age of the tested population was 44.6 ± 20.4 years, and 56.7% were male. MTB was detected in 1,083 tests (15.7%).

MTB detection varied significantly across study years (χ² = 28.46, p < 0.001), with positivity ranging from 9.8% in 2022 to 20.9% in 2021. Among MTB-positive tests, 192/1,083 (17.7%) showed rifampicin resistance. The annual proportion of rifampicin resistance ranged from 9.5% in 2020 to 23.1% in 2023 and varied significantly across years (χ² = 27.13, p < 0.001).

Low MTB bacterial load was significantly more frequent among rifampicin-resistant cases. In multivariable analysis, female sex was associated with higher odds of rifampicin resistance after adjustment for age and MTB bacterial-load category (aOR = 1.44, 95% CI: 1.02–2.02; p = 0.037), while low MTB bacterial load was independently associated with rifampicin resistance after adjustment for age and sex (aOR = 9.62, 95% CI: 5.77–16.04; p < 0.001).</p><p>MTB detection and rifampicin resistance showed substantial year-to-year variation among patients tested at UERH during 2019–2024.

The 17.7% rifampicin-resistance proportion represents a hospital-based estimate among MTB-positive GeneXpert-tested cases and should not be interpreted as the population prevalence of RR-TB in the Upper East Region. The observed pattern nevertheless warrants further investigation to determine the contribution of referral patterns, targeted testing, previous treatment, and other programme factors to the high proportion of rifampicin resistance observed at this referral facility.</p></div>