Drug-resistant tuberculosis outcomes in South Kivu Province, Democratic Republic of Congo, during a humanitarian crisis (2018–2024)

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ID: 313522
2026
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Abstract
Abstract Background Drug-resistant tuberculosis (DR-TB) management in fragile, conflict-affected settings remains challenging. South Kivu province, has faced protracted insecurity and recent outbreaks (COVID-19, mpox). We assessed treatment outcomes and predictors among DR-TB patients managed under programmatic conditions. Methods We conducted a retrospective provincial cohort study of all patients registered in electronic Tuberculosis registry with DR-TB in South-Kivu from January 2018 to June 2024. Primary outcome was treatment success; unsuccessful outcomes. We summarized characteristics, performed Kaplan–Meier functions for time to outcome, and fitted multivariable logistic regression and Cox proportional hazards models to identify predictors of unsuccessful outcomes. Results Among 277 DR-TB patients (median age 37 years; 3–75), overall treatment success was 77.6%, mortality 13.4%, and loss to follow-up (LTFU) 8.6%. HIV status was negative in 79.1%, and positive in 9.4%. Bedaquiline (BDQ)-containing regimens were used in 100%. In adjusted analyses, rural residence was protective against unsuccessful outcome (aOR 0.42; 95% CI 0.21–0.82; p=0.011), whereas retreatment other than relapse was associated with higher odds of unsuccessful outcome (aOR 2.04; 95% CI 1.09–3.81; p=0.026). Findings were consistent in time-to-event models (rural aHR 0.50; 95% CI 0.29–0.85; p=0.011; retreatment aHR 1.71; 95% CI 1.03–2.83; p=0.038). Conclusions In a humanitarian crisis context, programmatic all-oral DR-TB care achieved success exceeding the WHO ≥75% target. Persistently high mortality and LTFU—concentrated among urban residents and retreatment (non-relapse) cases—highlight the need for targeted urban patient-tracing, strengthened referral/continuity mechanisms, and uninterrupted drug supply. Results support scale-up of short, all-oral regimens with context-specific adherence support in fragile settings.
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Authors Eric Mulume Musafiri, Barhwamire Théophile Kabesha, Freddy Birembano, Rosette Nyota, Maryska Chimanuka Mapendo, Jean Paul Chirambiza, Trésor Kashinde Mosomo, Edmond Ntabe Namegabe
Journal Open forum infectious diseases
Year 2026
DOI
10.1093/ofid/ofag303
URL
https://doi.org/10.1093/ofid/ofag303
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