Prevalence, risk factors and outcomes of multidrug resistant Tuberculosis identified by GeneXpert MTB/RIF Assay in Bukavu, Democratic Republic of the Congoudud

摘要

Background: Tuberculosis (TB) has been the top-ranked infectious disease in human history for a very long time. According to World Health Organization (WHO), Democratic Republic of the Congo (DRC) has been high HIV/TB co-infection burden area for decades. However, MDR-TB were underreported in DRC due to the incompetent healthcare infrastructure and the lack of diagnostic method. ududMethod: This study aims to provide more epidemiological information on the prevalence of multidrug resistant tuberculosis (MDR-TB) infection identified by GeneXpert MTB/RIF assay, which is a new diagnostic method. The data were collected at the General Referral Hospital of Bukavu, DRC. Subject population was the suspected TB patients who visited the hospital of Bukavu, DRC. Retrospective analyses were done based on those data to identify risk factors. In addition, multiple statistical analyses, including multivariate logistic regression, Pearson Chi-square test were performed to investigate how the TB prevalence and treatment outcomes relate to risk factors and GeneXpert assay. ududResults: The Prevalence of all TB in the study population is 15.6% as identified by GeneXpert Assay. MDR-TB prevalence is 3.2% among the whole study population and 20% among TB positive subgroup. Logistic regression showed that previous TB episode and HIV known status are risk factors for developing MDR-TB. However, no risk factor for treatment failure was found in this study.ud udConclusions: GeneXpert Assay provided reliable TB and MDR-TB prevalence data in the resource limited area Bukavu, DRC. We noticed that MDR-TB prevalence from our study is significantly higher than national level, which suggests severe underestimation of MDR-TB burden in DRC. However, loss to follow-up of treatment outcome and high proportion of HIV status unknown are significantly affecting the data validity of this study.ud udPublic Health Significance: The control of MDR-TB in DR Congo requires diagnostic methods that are not only easy to implement in resource limited area, but also fast in turnaround time for both TB infection and drug resistance detection. GeneXpert MTB/RIF assay is an ideal test, but lack of field test. This study provides solid evidence of the performance of GeneXpert assay in the field as a solution of MDR-TB underreported issue.ud