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.2020-04-282020-05-072020-04-282020-05-072020-03-01Ngabonziza 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.RMSID:212568339http://hdl.handle.net/10454/17785YesSETTING: 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.en(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/)MDR-TBMDR-TB programmatic managementMDR-TB treatmentRwandaTBArticlehttps://doi.org/10.5588/ijtld.19.0298CC-BY2020-04-28