Study shows success in MDR-TB treatment in DRC

RESEARCHERS have reported success in treating multidrug-resistant tuberculosis (MDR-TB) in post-conflict parts of the Democratic Republic of Congo (DRC).

MDR-TB is a form of TB that is resistant to at least two of the most potent antibiotics used to treat TB and when compared to drug-susceptible TB, MDR-TB treatment takes longer and is less effective as only around 50% of patients are cured.

Without effective therapy, people with MDR-TB can infect others who have never had TB before.

The DRC is home to an estimated 81 million people and a high-burden country for TB, TB/HIV and MDR-TB.

According to the World Health Organisation around 262 000 new cases of TB and 56 500 TB-related deaths occurred in the DRC in 2017.

The second Congo war started in 1997 and caused massive disruption of health-care services in the eastern DRC, contributing to an increase in TB cases and TB-related mortality.

In 2011, despite continuing civil conflict and militia activity, the Xpert MTB/RIF assay, a rapid molecular diagnostic test for TB, was introduced in South Kivu province in eastern DRC.

André Bulabula, of the Department of Global Health, Division of Health Systems and Public Health at Stellenbosch University, with colleagues from the DRC, reported a new cohort study of 16448 patients evaluated for TB between 2012 and 2017 in postconflict DRC.

The authors found rifampicin (an antibiotic) resistance in 170 of 1535 patients with TB. Nearly 47% of the RR-TB patients had never been diagnosed or treated for TB before, suggesting that many had been directly infected by contact with patients with RR-TB in their communities.

Cure was achieved in 30 out of 36 patients with RR-TB treated with a new nine-month regimen, compared to 84/114 patients treated with 20and 24-month conventional MDR-TB regimens.

Co-author Zacharie M Kashongwe, Professor of Pulmonology at the University of Kinshasa, said: “In this challenging setting for MDR-TB treatment, it is compelling that our programmatic findings are in line with those reported earlier from observational studies in Bangladesh and other sub-Saharan African countries.

“Our findings are also in agreement with interim results of the ongoing multinational STREAM randomised trial initiated by the International Union against Tuberculosis and Lung Diseases in 2012 with its main partner the British Medical Research Council, which showed that both the shorter and longer MDR-TB regimens achieved success in roughly 80% of participants.

“However, the shorter regimen is easier for patients to complete.”

Both the shorter and longer regimens achieved success… however, the shorter is easier

Zacharie M Kashongwe

Professor of Pulmonology, Kinshasa University