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 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.

中文翻译：

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冲突后东部刚果民主共和国Xpert MTB / RIF鉴定的耐利福平结核病的患病率，预测因素和成功的治疗结局，2012-2017年：省范围队列研究。

背景技术耐多药结核病（MDR-TB）危及全球结核病控制。冲突后地区，如东部民主共和国的南基伍省，尚未评估耐利福平（RR）结核（耐多药结核）的患病率和预测因素，以及标准治疗方案和缩短治疗方案的治疗效果刚果民主共和国（DRC）。我们旨在填补这一知识空白，并为刚果民主共和国国家结核病计划提供信息。方法2012年2月至2017年6月，通过痰涂片镜检和Xpert MTB / RIF（Xpert）评价成年人和儿童的肺结核。多因素logistic回归，Kaplan-Meier估计和Cox回归用于评估RR-的独立预测因子结核病和治疗失败/死亡。结果在1535名Xpert结核阳性患者中，有11％患有RR-TB。RR-TB的独立预测因素是痰涂片阳性（调整比值比[aOR] 2.42、95％置信区间[CI] 1.63-3.59），结核病的再治疗（aOR 4.92、95％CI 2.31-10.45）和一项或多项更多先前的TB发作（每集aOR 1.77，95％CI 1.01-3.10）。超过45％的RR-TB患者没有既往结核病史或治疗史。从Xpert诊断到开始RR-TB治疗的中位时间为12天（四分位间距3-60.2）。分别接受9个月和20/24个月耐多药结核病治疗的患者中有30/36（83％）和84/114（74％）的患者治愈（P = .06）。治疗失败/死亡的预测因素是没有直接观察到的治疗（DOT；调整后的危险比[aHR] 2.77，95％CI 1.2-6.66）和任何严重的药物不良事件（aHR 4.28，95％CI 1.88-9.71）。结论在这种冲突后环境中，RR-TB的患病率很高，可以实现良好的RR-TB治愈率。Xpert扩大规模；迅速启动更短，更安全，更有效的耐多药结核病治疗方案；关键需要治疗依从性支持以优化结果。