National Reference Laboratory Division, Department of Biomedical Services, Rwanda Biomedical Centre, Kigali, Rwanda, Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.
Tuberculosis and Other Respiratory Diseases Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda.
Int J Tuberc Lung Dis. 2020 Mar 1;24(3):329-339. doi: 10.5588/ijtld.19.0298.
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. To describe trends in diagnostic and treatment delays and estimate their effect on RR-TB mortality. 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. 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. 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.
2005 年，为应对利福平耐药结核病（RR-TB）发病率不断上升和治疗效果不佳的情况，卢旺达启动了 RR-TB 的规划管理，包括扩大系统利福平药物敏感性测试（DST）和标准化治疗的机会。为了描述诊断和治疗延迟的趋势，并估计其对 RR-TB 死亡率的影响。对 2005 年 7 月 1 日至 2016 年 12 月 31 日期间向世界卫生组织报告的 876 例 RR-TB 患者中 748 例（85.4%）的个体水平数据进行回顾性分析。使用逻辑回归估计诊断和治疗延迟对 RR-TB 死亡率的影响。2006 年至 2016 年间，中位诊断延迟从 88 天显著缩短至 1 天，治疗延迟从 76 天缩短至 3 天。同时，RR-TB 死亡率从 2006 年的 30.8%显著下降至 2016 年的 6.9%。开始多药耐药结核病（MDR-TB）治疗的总延迟超过 100 天与死亡风险增加两倍以上相关。当延迟时间较长时，经验性 RR-TB 治疗开始与死亡率降低相关。诊断和治疗延迟的减少降低了 RR-TB 的死亡率。我们预计，RR-TB 的普遍检测、缩短诊断和治疗延迟以及有效的标准化 MDR-TB 治疗将进一步降低卢旺达 RR-TB 的死亡率。
