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

• Main Authors: Ngabonziza, J.-C.S., Habimana, Y.M., Decroo, T., Migambi, P., Dushime, A., Mazarati, J.B., Rigouts, L., Affolabi, D., Ivan, E., Meehan, Conor J., Van Deun, A., Fissette, K., Habiyambere, I., Nyaruhirira, A.U., Turate, I., Semahore, J.M., Ndjeka, N., Muvunyi, C.M., Condo, J.U., Gasana, M., Hasker, E., Torrea, G., de Jong, B.C.
• Language: en
• Published: 2020
• Subjects: MDR-TB; MDR-TB programmatic management; MDR-TB treatment; Rwanda; TB
• Online Access: http://hdl.handle.net/10454/17785

Yes === 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.