Background: The treatment of MDR-TB with second line drug is long, complex and costly, and has a considerable rate of adverse effects. The survival is short and mortality is high, particularly in developing countries. Even though MDR-TB treatment was started in 2013 Survival of MDRTB treatment in peripheral/third generation Treatment Initiation Centers (TIC) was not assessed. Therefore this study tried to assess the survival status and treatment outcome of MDR-TB treatment in the two TIC of SNNPR. Methods: A retrospective cohort study was conducted at Treatment Initiation Centers (TIC) in Yirgalem and Queen Eleni Memorial hospital. Coxproportional hazard regression model was built and variables that had P-value <0.25 in bivariate analysis considered candidates for multivariate analysis to determine independent predictors of mortality by using P-value < 0.05. Results: A total of 154 patients were followed for 186.5 person-year of observation; during the follow up period 13 (8.44%) patients were died making an overall incidence density rate of 7 (95% CI=5.62-8.84) per 100 Person year. Survival at the end of 1st, 2nd, 3rd, and 4th month was 98%, 97%, 95% and 92% respectively. Presence of medical complication [AHR=4.3, 95% CI =2.3-8.71], drug side effect [AHR=2.6, 95% CI =1.7-3.5], seropositivity [AHR=3.15, 95% CI =2.21-6.67], and baseline weight [AHR=0.9, 95% CI =0.82-0.98]. were predicted mortality. Conclusion and recommendations: The incidence of death and treatment outcomes was comparable to other studies. Intervention to further reduce deaths has to focus on patients with comorbidities, HIV, adverse effect and smaller base line body weight.