Reduction of diagnostic and treatment delays reduces rifampicin-resistant tuberculosis mortality in Rwanda

J-C S. Ngabonziza, Y. M. Habimana, T. Decroo, P. Migambi, A. Dushime, J. B. Mazarati, L. Rigouts, D. Affolabi, E. Ivan, C. J. Meehan, A. Van Deun, K. Fissette, Habiyambere, A. U. Nyaruhirira, Innocent Turate, J. M. Semahore, N. Ndjeka, C. M. Muvunyi, J. U. Condo, M. GasanaE. Hasker, G. Torrea, B. C. de Jong

Research output: Contribution to journalA1: Web of Science-article

Abstract

SETTING: In 2005, in response to the increasing prevalence of rifampicin-resistant tuberculosis (RR -TB) and poor treatment outcomes, Rwanda initiated the programmatic management of RR-TB, including expanded access to systematic rifampicin drug suscep-tibility testing (DST) and standardised treatment.

OBJECTIVE: To describe trends in diagnostic and treatment delays and estimate their effect on RR-TB mortality.

DESIGN: Retrospective analysis of individual-level data including 748 (85.4%) of 876 patients diagnosed with RR-TB notified to the World Health Organization between 1 July 2005 and 31 December 2016 in Rwanda. Logistic regression was used to estimate the effect of diagnostic and therapeutic delays on RR-TB mortality.

RESULTS: Between 2006 and 2016, the median diag-nostic delay significantly decreased from 88 days to 1 day, and the therapeutic delay from 76 days to 3 days. Simultaneously, RR-TB mortality significantly de-creased from 30.8% in 2006 to 6.9% in 2016. Total delay in starting multidrug-resistant TB (MDR-TB) treatment of more than 100 days was associated with more than two-fold higher odds for dying. When delays were long, empirical RR-TB treatment initiation was associated with a lower mortality.

CONCLUSION: The reduction of diagnostic and treat-ment delays reduced RR-TB mortality. We anticipate that universal testing for RR-TB, short diagnostic and therapeutic delays and effective standardised MDR-TB treatment will further decrease RR-TB mortality in Rwanda.

Original languageEnglish
JournalInternational Journal of Tuberculosis and Lung Disease
Volume24
Issue number3
Pages (from-to)329-339
Number of pages12
ISSN1027-3719
DOIs
Publication statusPublished - 2020

Keywords

  • TB
  • Rwanda
  • MDR-TB programmatic management
  • MDR-TB diagnosis
  • MDR-TB treatment
  • XPERT MTB/RIF
  • DRUG-RESISTANCE
  • IMPACT
  • OUTCOMES
  • SPREAD
  • TIME
  • COST

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