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Background: Evidence based information on the proportion &amp; trend of primary resistance among multidrug resistance (MDR) TB patients is important for designing effective strategies in the control of the disease. Methods: A retrospective record review of 348 MDR/RR-TB patients treated at All African Leprosy Rehabilitation &amp; Training (ALERT) Center from January 2014- December 2018. Categorical variables were compared using Chi-square/Fisher exact test as appropriate. Trend analysis was done using chi-square &amp; linear regression. Logistic regression analysis was done to determine the factors associated with primary MDR/RR TB. Adjusted Odds Ratio (AOR) with 95% CI and p value < 5% were used to report factors associated. Result: Proportion of primary resistance among MDR/RR TB patients was 25.9% with 95% CI 21.3–30.3%. The proportion increased form 9.7% in 2014 to 43.4% in 2018 at a yearly increasing rate of 9.27%. Contact history to TB patient &amp; year of diagnosis 2017 and 2018 were significantly associated with primary resistance AOR (95% CI) &amp; p value 4.15(1.75–9.84) p = 0.001, 3.87(1.44–10.39) p = 0.007, 3.43(1.20–9.84) p = 0.022 respectively. Conclusion: The study revealed a high proportion of primary resistance among MDR/RR TB during the study period with a linearly increasing fashion thus a need for due attention in the efforts to control MDR TB.