Diagnosis of Multi-Drug Resistant (MDR) tuberculosis in the Democratic Republic of the Congo
6 July 2018
UAntwerp - Campus Drie Eiken - Building O - Auditorium O8 - Universiteitsplein 1 - 2610 WILRIJK (route: UAntwerpen, Campus Drie Eiken
Organization / co-organization:
Faculty of Medicine and Health Sciences
Prof G. Ieven & Prof M. Boelaert
PhD defence Michel Kaswa - Faculty of Medecine and Health Sciences
Presentation in English
In 2008, the World Health Organization (WHO) estimated that the total number of MDR-TB cases in DRC was 5600 (95%CI: 530-11 000). However, less than 2% of this estimated number were detected and put on specific treatment during that same year. The goal of this thesis was to provide the National TB Program (NTP) of DRC with evidence and guidance on how to improve the programmatic management of MDR-TB.
The first manuscript reports an investigation of a cluster of MDR-TB cases in the Mosango health district, DRC in 2008. The Mosango study underlined the need for novel tools to assess drug resistance and provided the rationale for the subsequent work.
We then assessed the diagnostic accuracy and feasibility of molecular line probe assays for rapid detection of RMP,INH, FQ and aminoglycoside resistance. Our findings suggest to interpret MTBDR sl results with caution when the interpretation is solely based on the absence of a wildtype band without confirmation by visualization of a mutant band.
Building on the results, we decided to analyze the burden of drug resistant TB and to address the surveillance of TB resistance in Kinshasa, DRC in the third paper. Although there seemed to be a trend towards increased resistance, this was not confirmed by triangulation of our findings with registered recurrence cases.
In the meantime, a new molecular tool for diagnosing TB and resistance to RMP had been introduced in DRC, the Xpert® MTB/RIF assay (Cepheid, USA). We used it in 2015 to document the emergence of TB/MDR-TB cases in a prison setting in Mbuji-Mayi in DRC to guide appropriate treatment and infection control measures. The overall prevalence rate of confirmed TB among the 918 prisoners incarcerated was 21%. Among those there were 14 TB rifampicin resistant (TB-RR) cases. All TB and TB-RR have been put on treatment. Overcrowding and poor nutritional status were the major risks factors associated with high TB incidence in this prison.
In conclusion, this thesis provides key information on the emergence of drug-resistant TB in DRC, its public health impact, experience gained in patient management and strategies for addressing drug resistance within NTP. Laboratory services, although crucial, are often the weakest link in the health system, receiving low priority and inadequate resources. For TB control, laboratory strengthening is a priority, including improved access to and use of existing diagnostics as well as the development and implementation of appropriate new technologies.