Tuberculosis and Other Respiratory Communicable Diseases Division; HIV/AIDS, Disease Prevention and Control Department; Rwanda Biomedical Centre, Kigali, Rwanda.
National Reference Laboratory, Department of Biomedical Services, Rwanda Biomedical Centre, Kigali, Rwanda.
Int Health. 2023 Jul 4;15(4):357-364. doi: 10.1093/inthealth/ihac039.
Since the roll-out of the Xpert MTB/RIF assay, continuous surveillance can provide an estimate of rifampicin-resistant TB (RR-TB) prevalence, provided high drug susceptibility testing (DST) coverage is achieved. We use national data from Rwanda to describe rifampicin DST coverage, estimate the prevalence of RR-TB and assess its predictors.
Routinely collected DST data were entered into an electronic TB case-based surveillance system. DST coverage was calculated among all bacteriologically confirmed pulmonary TB patients notified from 1 July 2019 to 30 June 2020 in Rwanda. The prevalence of RR-TB was estimated among those with DST results. Univariable and multivariable analysis was performed to explore predictors for RR TB.
Among 4066 patients with bacteriologically confirmed pulmonary TB, rifampicin DST coverage was 95.6% (4066/4251). RR-TB was diagnosed in 73 patients. The prevalence of RR-TB was 1.4% (53/3659; 95% CI 1.09 to 1.89%) and 4.9% (20/406; 95% CI 3.03 to 7.51%) in new and previously treated TB cases, respectively. Predictors of RR-TB were: (1) living in Kigali City (adjusted OR [aOR] 1.65, 95% CI 1.03 to 2.65); (2) previous TB treatment (aOR 3.64, 95% CI 2.14 to 6.19); and (3) close contact with a known RR-TB patient (aOR 11.37, 95% CI 4.19 to 30.82).
High rifampicin DST coverage for routine reporting allowed Rwanda to estimate the RR-TB prevalence among new and previously treated patients.
自从 Xpert MTB/RIF 检测法推出以来，只要实现了较高的药物敏感性检测（DST）覆盖率，连续监测就可以提供利福平耐药结核（RR-TB）的流行率估计。我们使用来自卢旺达的国家数据来描述利福平 DST 覆盖率，估计 RR-TB 的流行率，并评估其预测因素。
定期收集的 DST 数据被输入到一个基于电子结核病例的监测系统中。在卢旺达，2019 年 7 月 1 日至 2020 年 6 月 30 日期间，对所有经细菌学确诊的肺结核患者进行了通知，计算了 DST 覆盖率。对有 DST 结果的患者进行了 RR-TB 的患病率估计。进行了单变量和多变量分析，以探讨 RR-TB 的预测因素。
在 4066 例经细菌学确诊的肺结核患者中，利福平 DST 覆盖率为 95.6%（4066/4251）。73 例诊断为 RR-TB。RR-TB 的患病率分别为新发病例和既往治疗病例的 1.4%（53/3659；95%CI 1.09 至 1.89%）和 4.9%（20/406；95%CI 3.03 至 7.51%）。RR-TB 的预测因素包括：（1）居住在基加利市（调整后的比值比[OR] 1.65，95%CI 1.03 至 2.65）；（2）既往 TB 治疗（aOR 3.64，95%CI 2.14 至 6.19）；和（3）与已知 RR-TB 患者密切接触（aOR 11.37，95%CI 4.19 至 30.82）。
常规报告中高的利福平 DST 覆盖率使卢旺达能够估计新发病例和既往治疗病例中 RR-TB 的流行率。
