Implementation of multidrug-resistant tuberculosis (MDR-TB) treatment in Gabon: lessons learnt from the field

Abstract

Purpose Since May 2016, WHO recommended a 9-12 month short-treatment regimen for multidrug-resistant tuberculosis (MDR-TB) treatment known as the 'Bangladesh Regimen'. However, limited data exist on the appropriateness thereof, and its implementation in low-and middle-income countries (LMIC). We report here on the pilot phase of the evaluation of the Bangladesh regimen in Gabon, prior to its endorsement by the WHO. Methods This ongoing observational study started in September 2015. Intensive training of hospital health workers as well as community information and education were conducted. GeneXpert-confirmed MDR-TB patients received the secondline anti-tuberculosis drugs (4KmMfxPtoHCfzEZ/5MfxCfzEZ). Sputum smears and cultures were done monthly. Adverse events were monitored daily. Results Eleven patients have been treated for MDR-TB piloting the short regimen. All were HIV-negative and presented in poor health with extensive pulmonary lesions. The overall sputum culture conversion rate was 64% after 4 months of treatment. Three patients developed marked hearing loss; one a transient cutaneous rash. Of 11 patients in our continuous care, 7 (63.6%) significantly improved clinically and bacteriologically. One (9.1%) patient experienced a treatment failure, two (18.2%) died, and one (9.1%) was lost to follow up. Conclusions Our pioneering data on systematic MDR-TB treatment in Gabon, with currently almost total absence of resistance against the second-line drugs, demonstrate that a 9-month regimen has the capacity to facilitate early culture negativity and sustained clinical improvement. Close adverse events monitoring and continuous care are vital to success.

Resistance patterns among drug-resistant tuberculosis patients and trends-over-time analysis of national surveillance data in Gabon, Central Africa

“…In our study, RR-TB was most frequently observed in 25- to 35-year-old individuals. This is in line with the baseline characteristics of TB in Gabon reported earlier [ 8 , 22 ]. Our findings are comparable with what was reported by other studies conducted in Africa [ 9 , 23 , 24 ].…”

“…Gabon is one of the high-burden tuberculosis countries with an incidence of 527 per 100,000 population [ 5 , 6 ], with a high prevalence of multidrug-resistant tuberculosis (MDR-TB) [ 7 ]. The alarming situation of the emergence of MDR-TB triggered a major effort to establish molecular surveillance and clinical care capacity in the country [ 7 , 8 ].…”

Knowledge, attitudes and practices regarding tuberculosis amongst healthcare workers in Moyen-Ogooué Province, Gabon

“…Regarding the high TB incidence and the absence of national TBIC guidelines at the time of the study, we assume that HCWs in Gabon are at high risk to become infected with TB, and thus to develop active disease. The situation is aggravated by a considerable HIV prevalence as well as a high proportion of MDR-TB [8][9][10]. At the time of the study, there was no systematic TB training program implemented for HCWs in Gabon.…”

Non-communicable disease co-morbidity and associated factors in tuberculosis patients: A cross-sectional study in Gabon

“…Gabon is a high-burden TB country, 11 , 12 with an estimated incidence of 521 TB cases per 100,000 inhabitants reported by the World Health Organization (WHO) in 2019. 13 Around 31% of deaths in Gabon are caused by NCDs.…”