Background Rwanda conducted a national tuberculosis (TB) prevalence survey to determine the magnitude of TB in the country and determine to what extent the national surveillance system captures all TB cases. In addition we measured the patient diagnostic rate, comparing the measured TB burden data with the routine surveillance data to gain insight into how well key population groups are being detected. Methods A national representative nationwide cross-sectional survey was conducted in 73 clusters in 2012 whereby all enrolled participants (residents aged 15 years and above) were systematically screened for TB by symptoms and chest X-ray (CXR). Those with either clinical symptoms (cough of any duration) and/or CXR abnormalities suggestive of TB disease were requested to provide two sputum samples (one spot and one morning) for smear examination and solid culture. Results Of the 45,058 eligible participants, 43,779 were enrolled in the survey. Participation rate was high at 95.7% with 99.8% of participants undergoing both screening procedures and 99.0% of those eligible for sputum examination submitting at least one sputum sample. Forty cases of prevalent mycobacterium tuberculosis (MTB) and 16 mycobacteria other than tuberculosis (MOTT) cases were detected during the survey. Chest x-ray as screening tool had 3 and 5 times greater predictive odds for smear positive and bacteriological confirmed TB than symptom screening alone respectively. A TB prevalence of 74.1 (95% CI 48.3-99.3) per 100,000 adult population for smear positive TB and 119.3 (95% CI 78.8-PLOS ONE
We validated the implementation of the INNO-LiPA Rif.TB line probe assay, a diagnostic test for rapid detection of multidrug-resistant tuberculosis (MDR-TB), in Rwanda. No substantial difference was found between results obtained in Rwanda and results obtained in Belgium with the same samples. This rapid diagnostic test for MDR-TB can therefore be reliably implemented in a resource-poor setting.
BackgroundLeprosy, or Hansen’s disease, is a chronic, infectious disease caused by Mycobacterium leprae. It remains one of the leading causes of deformity and physical disability.ObjectiveWe analysed laboratory records to assess trends in prevalence rates and case detection rates (CDRs) in Rwanda.MethodsA retrospective review of detected leprosy cases from the records of the Rwanda National Reference Laboratory over a 17-year period (1995–2011) was conducted. Skin biopsy samples were analysed microscopically using Ziehl-Neelsen staining technique to identify M. leprae.ResultsCumulatively, 266 suspected cases were reported between 1995 and 2011. Of the suspected cases, 77 (28.9%) were laboratory confirmed as having leprosy. Among detected cases, 59 (76.6%) were men and 18 (23.4%) women. The male:female ratio was 3:1. There were 77 registered leprosy cases over the 17-year period of the study, and the prevalence rate was 0.005 per 10 000 population. A gradual decrease in the prevalence rate was observed from 0.015 per 10 000 population in 2003 to 0.003 per 10 000 population in 2010. From 1995 to 2011, the CDR did not exceed one per 10 000 population.ConclusionThis laboratory review demonstrates a declining trend in prevalence rates and CDR during the period of the study. Early case detection and a sustainable leprosy control programme remain the cornerstones of reducing the physical and socio-economic burden of leprosy in Rwanda.
Summary background Multidrug-resistant (MDR) tuberculosis (TB) poses an important challenge in TB management and control. Rifampicin resistance (RR) is a solid surrogate marker of MDR-TB. We investigated the RR-TB clustering rates, bacterial population dynamics to infer transmission dynamics, and the impact of changes to patient management on these dynamics over 27 years in Rwanda. Methods We analysed whole genome sequences of a longitudinal collection of nationwide RR-TB isolates. The collection covered three important periods: before programmatic management of MDR-TB (PMDT; 1991–2005), the early PMDT phase (2006–2013), in which rifampicin drug-susceptibility testing (DST) was offered to retreatment patients only, and the consolidated phase (2014–2018), in which all bacteriologically confirmed TB patients had rifampicin DST done mostly via Xpert MTB/RIF assay. We constructed clusters based on a 5 SNP cut-off and resistance conferring SNPs. We used Bayesian modelling for dating and population size estimations, TransPhylo to estimate the number of secondary cases infected by each patient, and multivariable logistic regression to assess predictors of being infected by the dominant clone. Results Of 308 baseline RR-TB isolates considered for transmission analysis, the clustering analysis grouped 259 (84.1%) isolates into 13 clusters. Within these clusters, a single dominant clone was discovered containing 213 isolates (82.2% of clustered and 69.1% of all RR-TB), which we named the “Rwanda Rifampicin-Resistant clone” (R3clone). R3clone isolates belonged to Ugandan sub-lineage 4.6.1.2 and its rifampicin and isoniazid resistance were conferred by the Ser450Leu mutation in rpoB and Ser315Thr in katG genes, respectively. All R3clone isolates had Pro481Thr, a putative compensatory mutation in the rpoC gene that likely restored its fitness. The R3clone was estimated to first arise in 1987 and its population size increased exponentially through the 1990s’, reaching maximum size (∼84%) in early 2000 s’, with a declining trend since 2014. Indeed, the highest proportion of R3clone (129/157; 82·2%, 95%CI: 75·3–87·8%) occurred between 2000 and 13, declining to 64·4% (95%CI: 55·1-73·0%) from 2014 onward. We showed that patients with R3clone detected after an unsuccessful category 2 treatment were more likely to generate secondary cases than patients with R3clone detected after an unsuccessful category 1 treatment regimen. Conclusions RR-TB in Rwanda is largely transmitted. Xpert MTB/RIF assay as first diagnostic test avoids unnecessary rounds of rifampicin-based TB treatment, thus preventing ongoing transmission of the dominant R3clone. As PMDT was intensified and all TB patients accessed rifampicin-resistance testing, the nationwide R3clone burden declined. To our knowledge, our findings provide the first evidence supporting the impact of univers...
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