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; null Habiyambere; A. U. Nyaruhirira; Innocent Turate; J. M. Semahore; N. Ndjeka; C. M. Muvunyi; J. U. Condo; M. Gasana; E. Hasker; G. Torrea; B. C. de Jong

doi:10.5588/ijtld.19.0298

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

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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 language	English
Journal	International Journal of Tuberculosis and Lung Disease
Volume	24
Issue number	3
Pages (from-to)	329-339
Number of pages	12
ISSN	1027-3719
DOIs	https://doi.org/10.5588/ijtld.19.0298
Publication status	Published - 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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2020ijtl0329Final published version, 595 KBLicence: CC BY

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Ngabonziza, J.-C. S., Habimana, Y. M., Decroo, T., Migambi, P., Dushime, A., Mazarati, J. B., Rigouts, L., Affolabi, D., Ivan, E., Meehan, C. J., Van Deun, A., Fissette, K., Habiyambere, Nyaruhirira, A. U., Turate, I., Semahore, J. M., Ndjeka, N., Muvunyi, C. M., Condo, J. U., ... de Jong, B. C. (2020). Reduction of diagnostic and treatment delays reduces rifampicin-resistant tuberculosis mortality in Rwanda. International Journal of Tuberculosis and Lung Disease, 24(3), 329-339. https://doi.org/10.5588/ijtld.19.0298

@article{90e8338c4a6d40fa9b41f1e051e9814f,

title = "Reduction of diagnostic and treatment delays reduces rifampicin-resistant tuberculosis mortality in Rwanda",

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.",

keywords = "TB, Rwanda, MDR-TB programmatic management, MDR-TB diagnosis, MDR-TB treatment, XPERT MTB/RIF, DRUG-RESISTANCE, IMPACT, OUTCOMES, SPREAD, TIME, COST",

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

note = "OGOA; FTX; PPT; (CC BY 4.0)",

year = "2020",

doi = "10.5588/ijtld.19.0298",

language = "English",

volume = "24",

pages = "329--339",

journal = "International Journal of Tuberculosis and Lung Disease",

issn = "1027-3719",

publisher = "International Union Against Tuberculosis and Lung Disease",

number = "3",

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Ngabonziza, J-CS, Habimana, YM, Decroo, T, Migambi, P, Dushime, A, Mazarati, JB, Rigouts, L, Affolabi, D, Ivan, E, Meehan, CJ, Van Deun, A, Fissette, K, Habiyambere, Nyaruhirira, AU, Turate, I, Semahore, JM, Ndjeka, N, Muvunyi, CM, Condo, JU, Gasana, M, Hasker, E , Torrea, G & de Jong, BC 2020, 'Reduction of diagnostic and treatment delays reduces rifampicin-resistant tuberculosis mortality in Rwanda', International Journal of Tuberculosis and Lung Disease, vol. 24, no. 3, pp. 329-339. https://doi.org/10.5588/ijtld.19.0298

TY - JOUR

T1 - Reduction of diagnostic and treatment delays reduces rifampicin-resistant tuberculosis mortality in Rwanda

AU - Ngabonziza, J-C S.

AU - Habimana, Y. M.

AU - Decroo, T.

AU - Migambi, P.

AU - Dushime, A.

AU - Mazarati, J. B.

AU - Rigouts, L.

AU - Affolabi, D.

AU - Ivan, E.

AU - Meehan, C. J.

AU - Van Deun, A.

AU - Fissette, K.

AU - Habiyambere, null

AU - Nyaruhirira, A. U.

AU - Turate, Innocent

AU - Semahore, J. M.

AU - Ndjeka, N.

AU - Muvunyi, C. M.

AU - Condo, J. U.

AU - Gasana, M.

AU - Hasker, E.

AU - Torrea, G.

AU - de Jong, B. C.

N1 - OGOA; FTX; PPT; (CC BY 4.0)

PY - 2020

Y1 - 2020

N2 - 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.

AB - 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.

KW - TB

KW - Rwanda

KW - MDR-TB programmatic management

KW - MDR-TB diagnosis

KW - MDR-TB treatment

KW - XPERT MTB/RIF

KW - DRUG-RESISTANCE

KW - IMPACT

KW - OUTCOMES

KW - SPREAD

KW - TIME

KW - COST

U2 - 10.5588/ijtld.19.0298

DO - 10.5588/ijtld.19.0298

M3 - A1: Web of Science-article

SN - 1027-3719

VL - 24

SP - 329

EP - 339

JO - International Journal of Tuberculosis and Lung Disease

JF - International Journal of Tuberculosis and Lung Disease

IS - 3

ER -

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

Abstract

Keywords

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