High treatment success among individuals with rifampicin-resistant tuberculosis in Botswana: A retrospective cohort study

Rifampicin-resistant tuberculosis (RR-TB) remains a global health challenge, which is often characterized by limited treatment options and increased morbidity and mortality. Despite advances in diagnostics and the introduction of new drug regimens, treatment success for drug-resistant TB remains low. There is limited data on clinical, sociodemographic, and microbiological factors that influence patient outcomes. The aim of the study is to evaluate TB treatment outcomes among individuals diagnosed with RR-TB and to identify predictors of favourable and unfavourable treatment outcomes.

We conducted a retrospective study to analyse treatment outcomes of 162 individuals diagnosed with RR-TB using GeneXpert MTB/RIF and phenotypic drug susceptibility testing (pDST) from 2016 to 2023. Treatment outcome proportions were estimated using the binomial exact method with 95 % confidence intervals (CI). Predictors associated with unfavourable treatment outcomes were assessed using logistic regression models.

Of the 162 individuals, 102(62.7 %) were male with a median age of 39 (interquartile range (IQR): 29-50). Most individuals, 78(48.1 %), were from the Greater Gaborone health district, and 88(54.3 %) were people living with HIV (PLWH). Among included individuals, 137(84.6 %, 95 % CI: 78.2-89.7) were successfully treated. Males had higher odds of unfavourable treatment outcomes compared to females (OR = 1.70; 95 % CI: 0.73-3.98). Among those cured, a slightly higher proportion was observed among PLWH (71.8 %, 95 % CI: 62.1-80.3) compared to people not living with HIV (PNLWH) (69.2 %, 95 % CI: 58.7-78.5). However, the mortality rate was higher among PLWH (10.7 %; 95 % CI: 5.5-18.3) than among PNLWH (6.6 %; 95 % CI: 2.5-13.8). Those with a history of TB treatment had 1.03 odds of unfavourable treatment outcomes (95 % CI: 0.40-2.73); however, this association was not statistically significant.

Our study shows a high rate of successful treatment outcomes among individuals with RR-TB, with no significant difference based on sex, TB treatment history, or HIV status. Higher mortality among PLWH highlights the need for targeted interventions among high-risk groups.