J-C S Ngabonziza1, Y M Habimana2, T Decroo3, P Migambi2, A Dushime2, J B Mazarati4, L Rigouts5, D Affolabi6, E Ivan7, C J Meehan8, A Van Deun9, K Fissette10, I Habiyambere2, A U Nyaruhirira11, I Turate12, J M Semahore13, N Ndjeka14, C M Muvunyi15, J U Condo16, M Gasana2, E Hasker17, G Torrea10, B C de Jong10. 1. National Reference Laboratory Division, Department of Biomedical Services, Rwanda Biomedical Centre, Kigali, Rwanda, Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium. 2. Tuberculosis and Other Respiratory Diseases Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda. 3. Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium, Research Foundation Flanders, Brussels, Belgium. 4. Department of Biomedical Services, Rwanda Biomedical Centre, Kigali, Rwanda. 5. Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium. 6. Laboratoire de Référence des Mycobactéries, Cotonou, Benin. 7. National Reference Laboratory Division, Department of Biomedical Services, Rwanda Biomedical Centre, Kigali, Rwanda. 8. Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, School of Chemistry and Biosciences, University of Bradford, Bradford, UK. 9. Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, International Union Against Tuberculosis and Lung Disease, Paris, France. 10. Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp. 11. Management Sciences for Health, Pretoria, South Africa. 12. Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Centre, Kigali. 13. HIV, STIs, Hepatitis and Tuberculosis Programmes, World Health Organization Country Office, Kigali, Rwanda. 14. National Tuberculosis Programme, National Department of Health, Pretoria, South Africa. 15. Department of Clinical Biology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali. 16. Rwanda Biomedical Centre, Kigali, Rwanda. 17. Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
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 susceptibility 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 diagnostic delay significantly decreased from 88 days to 1 day, and the therapeutic delay from 76 days to 3 days. Simultaneously, RR-TB mortality significantly decreased 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 treatment 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.
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 susceptibility testing (DST) and standardised treatment. OBJECTIVE: To describe trends in diagnostic and treatment delays and estimate their effect on RR-TBmortality. 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-TBmortality. RESULTS: Between 2006 and 2016, the median diagnostic delay significantly decreased from 88 days to 1 day, and the therapeutic delay from 76 days to 3 days. Simultaneously, RR-TBmortality significantly decreased 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 treatment delays reduced RR-TBmortality. We anticipate that universal testing for RR-TB, short diagnostic and therapeutic delays and effective standardised MDR-TB treatment will further decrease RR-TBmortality in Rwanda.
Authors: Jean Claude S Ngabonziza; Leen Rigouts; Gabriela Torrea; Tom Decroo; Eliane Kamanzi; Pauline Lempens; Aniceth Rucogoza; Yves M Habimana; Lies Laenen; Belamo E Niyigena; Cécile Uwizeye; Bertin Ushizimpumu; Wim Mulders; Emil Ivan; Oren Tzfadia; Claude Mambo Muvunyi; Patrick Migambi; Emmanuel Andre; Jean Baptiste Mazarati; Dissou Affolabi; Alaine N Umubyeyi; Sabin Nsanzimana; Françoise Portaels; Michel Gasana; Bouke C de Jong; Conor J Meehan Journal: J Clin Tuberc Other Mycobact Dis Date: 2022-01-24
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