Factors associated with Multidrug-resistant Tuberculosis in Rwanda: Secondary data analysis of the Rwanda 2015 Drugs Resistance Tuberculosis Survey

  • Anti-microbial resistance
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Multidrug-resistant tuberculosis (MDR-TB) is a major threat for TB control globally. The Rwanda 2005 drugs resistance tuberculosis survey revealed that 3.9% of new TB patients and 9.4% of previously treated TB patients had multidrug-resistant tuberculosis. We used data from the 2015 follow-up drugs resistance TB survey to determine the prevalence and risk factors of multidrug-resistant tuberculosis in Rwanda.
This study involved secondary data analysis of the Rwanda 2015 drugs resistance tuberculosis survey. During the primary study, all patients with sputum smear-positive TB from all health facilities across the country were enrolled, over a period of six months from 26th January to 15th July 2015. Socio-demographics and clinical information were collected using a standard questionnaire. Drug susceptibility testing was performed to identify MDR-TB strains using Line Probe Assay and phenotypic techniques. MDR-TB was defined as TB due to Mycobacterium tuberculosis that is resistant to isoniazid and rifampicin with or without resistance to other drugs. We abstracted and analyzed data using Stata 13: conducting bivariate and multiple logistic regression to identify potential risk factors. P-values < 0.05 were considered as statistically significant.
Of the 1,221 smear-positive sputum specimens, Mycobacterium tuberculosis grew from 1,117(91.4%). Drug susceptibility testing revealed that 1,094 (97.9%) were susceptible, while 23 (2.1%) were confirmed with MDR-TB strains. The overall prevalence of MDR-TB was 2.1% (1.4% among new cases and 10.7% among previously TB treated cases). Among the HIV infected patients, 5.4% (11/205) had MDR-TB compared to 1.4% (12/912) among HIV negative patients [aOR=3.4 (95% CI: 1.4-8.07)]. Eleven percent (9/84) of previously treated TB patients had MDR-TB compared to 1.4% (14/1033) among new TB cases [aOR=7.2 (95% CI: 2.9-17.5)].
We identified HIV infection and previous TB treatment as probable risk factors of MDR-TB in Rwanda. We rec- ommended the strengthening of active surveillance of drug-resistant TB in these high-risk groups to allow timely detection and control. Following this study, systematic screening of HIV infected people and persons with history of TB has been revamped. GeneXpert test is used for the initial exam and then molecular testing done to detect MTB Rifampicin resistance.

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