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Reduction of diagnostic and treatment delays reduces rifampicin-resistant tuberculosis mortality in Rwanda
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.
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.
Publication Date
2020-03-01
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(c) 2020 The Authors. This is an Open Access article distributed under the Creative Commons CC-BY license (http://creativecommons.org/licenses/by/4.0/)
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2019-08-26
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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.
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Ngabonziza JS, Habimana YM, Decroo T et al (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.
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Article