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

Ngabonziza, S, Habimana, YM, Decroo, T, Migambi, P, Dushime, A, Mazarati, JB, Rigouts, L, Affolabi, D, Ivan, E, Meehan, CJ ORCID: https://orcid.org/0000-0003-0724-8343, Van Deun, A, Fissette, K, Habiyambere, I, Nyaruhirira, AU, Turate, I, Semahore, JM, Ndjeka, N, Muvunyi, CM, Condo, JU, Gasana, M, Hasker, E, Torrea, G and de Jong, BC, 2020. Reduction of diagnostic and treatment delays reduces rifampicin-resistant tuberculosis mortality in Rwanda. International Journal of Tuberculosis and Lung Disease, 24 (3), pp. 329-339. ISSN 1027-3719

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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 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.

Item Type:	Journal article
Publication Title:	International Journal of Tuberculosis and Lung Disease
Creators:	Ngabonziza, 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, I., Nyaruhirira, A.U., Turate, I., Semahore, J.M., Ndjeka, N., Muvunyi, C.M., Condo, J.U., Gasana, M., Hasker, E., Torrea, G. and de Jong, B.C.
Publisher:	International Union Against Tuberculosis and Lung Disease
Date:	1 March 2020
Volume:	24
Number:	3
ISSN:	1027-3719
Identifiers:	Number Type 10.5588/ijtld.19.0298 DOI 1627506 Other
Rights:	© 2020 The Union. This work is licensed under a Creative Commons Attribution 4.0 International License.
Divisions:	Schools > School of Science and Technology
Record created by:	Jonathan Gallacher
Date Added:	14 Dec 2022 09:27
Last Modified:	14 Dec 2022 09:27
URI:	https://irep.ntu.ac.uk/id/eprint/47658

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