Rifampicin resistant tuberculosis (RR-TB) affects half a million new patients worldwide each year. The National TB Programme of Rwanda made its control a priority, resulting in a decline in RR-TB cases notified. Building on a fruitful collaboration, we now propose to conduct innovative investigations that will inform further evidence-based control efforts. We showed that the Xpert MTB/RIF detects false resistance when the bacterial burden is low, which led to a revised nationwide diagnostic flow chart. In molecular epidemiological analyses spanning a quarter century, we identified a virulent strain, the “Rwanda RR clone”, that has fitness compensatory mutations, and still causes the majority of RR-TB in Rwanda. In the present proposal, firstly, we will expand the molecular epidemiological analysis to answer the question “who is next?”. Secondly, we will test with state of the art bioinformatics analyses the size of the total bacterial population. Thirdly, we will optimize diagnostics for the rapid detection of RR-TB, also by phenotypic tests, and specifically the Rwanda RR clone, integrating connectivity software of Xpert machines with a new to be developed qPCR. Fourthly, we will test an innovative case finding approach to further interrupt RR-TB transmission. By strengthening collaborations with colleagues in the Great Lakes region, together we plan to provide fundamental insights into RR-TB transmission dynamics and inform optimal next steps towards RR-TB control in Rwanda and elsewhere.
|Effective start/end date||1/01/21 → 31/12/24|
- Flemish Government - Department of Economy, Science & Innovation: €599,343.00