Prevalence, Predictors, and Successful Treatment Outcomes of Xpert MTB/RIF-identified Rifampicin-resistant Tuberculosis in Post-conflict Eastern Democratic Republic of the Congo, 2012-2017: A Retrospective Province-Wide Cohort Study
Prevalence, Predictors, and Successful Treatment Outcomes of Xpert MTB/RIF-identified Rifampicin-resistant Tuberculosis in Post-conflict Eastern Democratic Republic of the Congo, 2012-2017: A Retrospective Province-Wide Cohort Study
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DOI：
10.1093/cid/ciy1105
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发表时间：
2019-10-15
影响因子：
11.8
通讯作者：
Nachega, Jean B.
中科院分区：
文献类型：
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作者：
Bulabula, Andre N. H.;Nelson, Jenne A.;Nachega, Jean B.
背景资料。耐多药结核病(MDR-TB)危及全球结核病控制。在冲突后地区，如刚果民主共和国东部的南基伍省，尚未评估耐利福平结核病的患病率和预测因素，以及使用标准和缩短方案的治疗结果。我们的目标是填补这一知识空白，并向刚果民主共和国国家结核病规划提供信息。2012年2月至2017年6月对成人和儿童进行的一项回顾性队列研究，通过痰涂片显微镜和Xpert MTB/RIF(Xpert)评估肺结核。多变量Logistic回归、Kaplan-Meier估计和多变量Cox回归用于评估RR-TB和治疗失败/死亡的独立预测因素。在1535名结核病Xpert阳性患者中，11%患有RR-TB。RR-TB的独立预测因素为：痰涂片阳性(调整后的优势比[AOR]2.42，95%可信区间[CI]1.63-3.59)、重新治疗肺结核(AOR 4.92，95%可信区间2.31-10.45)、既往一次或多次结核病发作(AOR 1.77，95%可信区间1.01-3.10)。超过45%的RR-TB患者以前没有结核病病史或治疗。从Xpert诊断到RR-TB治疗开始的中位时间为12天(四分位数范围3-60.2)。在9个月和20个月/24个月的MDR-TB方案中，分别有30/36(83%)和84/114(74%)的患者治愈(P=0.06)。预测治疗失败/死亡的因素是缺乏直接观察治疗(DOT；调整风险比[AHR]2.77，95%可信区间1.2~6.66)和任何严重不良药物事件(AHR 4.28，95%可信区间1.88~9.71)。在RR-TB流行率较高的冲突后环境中，可以实现良好的RR-TB治愈率。扩大Xpert的规模；迅速启动更短、更安全、高效的耐多药结核病方案；以及支持治疗依从性，对于优化结果至关重要。
Background. Multidrug-resistant tuberculosis (MDR-TB) jeopardizes global TB control. The prevalence and predictors of Rifampicin-resistant (RR) TB, a proxy for MDR-TB, and the treatment outcomes with standard and shortened regimens have not been assessed in post-conflict regions, such as the South Kivu province in the eastern Democratic Republic of the Congo (DRC). We aimed to fill this knowledge gap and to inform the DRC National TB Program.Methods. A retrospective cohort study of adults and children evaluated for pulmonary TB by sputum smear microscopy and Xpert MTB/RIF (Xpert) from February 2012 to June 2017. Multivariable logistic regression, Kaplan-Meier estimates, and multivariable Cox regression were used to assess independent predictors of RR-TB and treatment failure/death.Results. Of 1535 patients Xpert-positive for TB, 11% had RR-TB. Independent predictors of RR-TB were a positive sputum smear (adjusted odds ratio [aOR] 2.42, 95% confidence interval [CI] 1.63-3.59), retreatment of TB (aOR 4.92, 95% CI 2.31-10.45), and one or more prior TB episodes (aOR 1.77 per episode, 95% CI 1.01-3.10). Over 45% of RR-TB patients had no prior TB history or treatment. The median time from Xpert diagnosis to RR-TB treatment initiation was 12 days (interquartile range 3-60.2). Cures were achieved in 30/36 (83%) and 84/114 (74%) of patients on 9- vs 20/24-month MDR-TB regimens, respectively (P =.06). Predictors of treatment failure/death were the absence of directly observed therapy (DOT; adjusted hazard ratio [aHR] 2.77, 95% CI 1.2-6.66) and any serious adverse drug event (aHR 4.28, 95% CI 1.88-9.71).Conclusions. Favorable RR-TB cure rates are achievable in this post-conflict setting with a high RR-TB prevalence. An expanded Xpert scale-up; the prompt initiation of shorter, safer, highly effective MDR-TB regimens; and treatment adherence support are critically needed to optimize outcomes.