Publication date: May 01, 2026
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. 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. 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-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 = .011), whereas retreatment other than relapse was associated with higher odds of unsuccessful outcome (aOR 2. 04; 95% CI 1. 09-3. 81; P = .026). Findings were consistent in time-to-event models (rural aHR 0. 50; 95% CI 0. 29-0. 85; P = .011; retreatment aHR 1. 71; 95% CI 1. 03-2. 83; P = .038). 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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| Concepts | Keywords |
|---|---|
| Bedaquiline | DR-TB |
| Democratic | humanitarian settings |
| Humanitarian | treatment outcomes |
| Tuberculosis |