Tehran University of Medical Sciences Journal of Biostatistics and Epidemiology 2383-4196 6 3 2020 12 31 162 169 Shamsa Kanwal National College of Business Administration & Economics, Lahore, Pakistan Abdul Akhtar Indus Hospital Karachi, Lahore, Pakistan 2020 06 17 2020 09 12 Introduction: Pakistan, a country with a 27 high burden countries of multidrug resistance tuberculosis. To predict the associated risk factors and proportion of loss to follow up among MDR-TB patients treated at PMDT sites of Punjab from 2017 to 2019. Methodology: This case control study based on the standardized reporting and recording case record forms called as Electronic Nominal Review System (ENRS) of National TB Control Program, Pakistan. A logistic regression model was used to assess risk factors of lost to follow up MDR-TB patients. Results: A total of 539 patients with MDR-TB were included in the final analysis. Among them, 207 patients (7.5%) had lost to follow up outcome at the end of the study. MDR-TB lost to follow up patients were more likely to report older age (AOR: 1.40, CI: 1.14-1.71, p=0.000),  history of lost to follow up from first line drugs treatment (AOR: 0.39, CI: 0.28-0.56, p=0.000), co-morbid (AOR:1.54, CI: 1.24-1.91, p=0.000), adverse reaction of second line drugs (AOR: 0.45, CI: 0.37-0.56, p=0.000), long distance between patient’s home and PMDT site (AOR: 0.68, CI: 0.52-0.89, p=0.001). Conclusion: The history of lost to follow up from first line drugs treatment, co-morbid, older age and long distance were independent risk factors of MDR-TB. Proper training for PMDT sites staff, friendly follow up services and psychological counseling may help to reduce lost to follow up. https://jbe.tums.ac.ir/index.php/jbe/article/view/344