Reduction of Diagnostic and Treatment Delays Reduces Rifampicin-Resistant Tuberculosis Mortality in Rwanda

Reduction of Diagnostic and Treatment Delays Reduces Rifampicin-Resistant Tuberculosis Mortality in Rwanda

By: J-C. S. Ngabonziza, Y. M. Habimana, T. Decroo, P. Migambi, A. Dushime, J. B. Mazarati, L. Rigouts, D. Affolabi, E. Ivan, C. Meehan, A. Van Deun, K. Fissette, I. Habiyambere, A. U. Nyaruhirira, others
Publication: International Journal of Tuberculosis and Lung Disease2020; 24 (3): 329-39. DOI: 10.5588/ijtld.19.0298.

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.