Studies on multidrug resistance tuberculosis in Rwanda: Turning off the tap

Tuberculosis control is challenged by the ongoing spread of multidrug-resistant tuberculosis (MDR-TB). Prompt initiation of appropriate treatment not only saves lives but also rapidly stops transmission; a vital goal of the “programmatic management of MDR-TB” (PMDT).
In this PhD proposal, we intend to document the impact of PMDT interventions on the diagnostic- and treatment delays, and the resulting genotypic clustering of MDR-TB over a decade in Rwanda. In addition, we aim to characterize mutations associated with rifampicin resistance that are not detected by the currently implemented methods, and measure their prevalence stratified by patients’ treatment history and HIV infection.
We will conduct a “before and after study” on the package of PMDT interventions, flanked by the 2005 and 2015 tuberculosis drug resistance surveys, including phylogeographic analysis of MDR-TB strains to study genotypic clustering in time and space, and will screen for ‘occult’ rifampicin resistance associated mutations.
We anticipate to characterize key ingredients in the PMDT and potential approaches to strengthen the diagnostic pathway. These findings will likely inform TB control in Rwanda and elsewhere, by identifying circulating MDR-TB clones and likely strategies that may curb their ongoing spread.