#Cid episode 1217 plus#
Tuberculosis diagnostic and treatment centers (red stars), plus those equipped with Xpert MTB/RIF (yellow dots) as well as GenoType MTBDR sl (purple dot) machines within the 34 health zones of the South Kivu Province, Democratic Republic (DR) of the Congo. Human immunodeficiency virus (HIV) status was not documented systematically, due to out-of-stock test kits. Ziehl-Neelsen sputum smear microscopy for acid-fast bacilli (AFB) and Xpert were performed on different sputum samples. TB cases were found and identified either passively (by referral) or actively (via symptom screening by community health workers ). While described as post-conflict, the eastern DRC is still considered unstable, given the continued presence of multiple active militias. We performed a secondary analysis of data collected routinely from adults and children and evaluated for suspected pulmonary TB at 10 Xpert-equipped CSDTs serving 34 health zones of the South Kivu province from 1 February 2012 to 30 June 2017 ( Figure 1). METHODS Study Design, Setting, and Population We aimed to assess the prevalence and predictors of RR-TB, as well as treatment outcomes, to inform the strategic plan of the DRC National TB Program (NTP) and guide models development to improve MDR-TB care in low- and middle-income countries (LMICs).
![cid episode 1217 cid episode 1217](https://www.frontiersin.org/files/Articles/665682/fpsyt-12-665682-HTML/image_m/fpsyt-12-665682-g001.jpg)
Both studies focused on strategies to improve finding TB cases and on early Xpert user experiences, but did not document the risk factors for, or clinical outcomes of, RR-TB treatment. Creswell et al reported a 5.3% prevalence of Xpert-diagnosed rifampicin-resistant TB (RR-TB) in South Kivu, compared to a 9.6% prevalence among smear-negative TB cases in the capital city Kinshasa, as reported by Mbonze et al. Laboratory capacities for Xpert were established at 10 TB diagnostic and treatment centres (CSDTs) in South Kivu province through the Stop TB Partnership’s TB REACH initiative. In 2012, South Kivu was the first province of eastern DRC to roll out the Xpert MTB/RIF assay (Xpert Cepheid, Sunnyvale, CA), a rapid genotypic assay for rifampicin susceptibility via rpoB mutation detection. The second Congo war, in the aftermath of the 1994 Rwandan genocide, caused a massive disruption of health-care services in the eastern DRC.
![cid episode 1217 cid episode 1217](https://img.youtube.com/vi/BfUcHxyYxvI/0.jpg)
Limited laboratory infrastructure for both MTB cultures and drug susceptibility testing (DST) makes the determination of the actual MDR-TB burden and of treatment outcomes challenging. Estimated DRC MDR-TB rates were 2.2% among new cases and 9.7% in retreatment cases.
![cid episode 1217 cid episode 1217](http://i.ytimg.com/vi/nMN7su1YHKo/hqdefault.jpg)
In 2017, among the 81 million people in DRC, there was an estimated TB incidence of 322/100 000 and an estimated 60 000 TB-related deaths. In contrast to downward trends in 30 high-burden countries, the Democratic Republic of the Congo (DRC) has had persistently high TB incidences and mortality rates. Multidrug-resistant tuberculosis (MDR-TB), defined as resistance to rifampicin and isoniazid, poses a global threat to TB control efforts. Multidrug-resistant TB, prevalence, predictors, treatment outcomes, eastern DR Congo