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

Journal Article
  • 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
International Journal of Tuberculosis and Lung Disease
2020; 24 (3): 329-39. DOI: 10.5588/ijtld.19.0298.


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.