High success treating rifampicin-resistant TB in Botswana

Tuberculosis that resists the key antibiotic rifampicin is a serious medical challenge worldwide. In Botswana, researchers led by corresponding author Tuelo Mogashoa examined how people diagnosed with rifampicin-resistant TB (RR-TB) fared on treatment. The team looked back at records from 2016 to 2023 to understand who recovered and who did not, and whether factors such as sex, prior TB treatment, or HIV status were linked to different outcomes. The study included 162 people with RR-TB; 102 (62.7%) were male, and the median age was 39 (interquartile range (IQR): 29-50). Nearly half, 78 (48.1%), were from the Greater Gaborone health district. More than half, 88 (54.3%), were people living with HIV (PLWH). By going back through these records, the researchers aimed to produce a clear picture of treatment success in a real-world setting, looking for patterns that could guide care and public health planning.

This was a retrospective cohort study of 162 individuals with RR-TB treated between 2016 and 2023. Treatment outcome proportions were estimated using the binomial exact method with 95% confidence intervals (CI). Predictors of treatment outcomes were assessed using logistic regression models. Overall, 137 of 162 individuals (84.6%, 95% CI [78.2, 89.7]) were successfully treated. Men had higher odds of unfavourable treatment outcomes than women (OR = 1.70; 95% CI [0.73, 3.98]), though this did not reach clear statistical significance in the study. Among those recorded as 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]). Mortality was higher among PLWH at 10.7% (95% CI [5.5, 18.3]) versus 6.6% (95% CI [2.5, 13.8]) in PNLWH. A history of prior TB treatment was associated with an odds ratio of 1.03 for unfavourable outcomes (95% CI [0.40, 2.73]), a result the authors report as not statistically significant.

The findings from Tuelo Mogashoa and colleagues point to strong overall performance in treating RR-TB in this Botswana cohort: most people (84.6%) were successfully treated. At the same time, the data highlight important nuances. While sex, prior TB treatment, and HIV status were not linked to large, statistically definitive differences in overall success in this analysis, the higher mortality seen among people living with HIV signals a persistent vulnerability. That pattern suggests the need for additional care and monitoring for PLWH who develop RR-TB, even where overall cure rates are high. The study supports continued investment in tracking treatment outcomes with robust methods such as the binomial exact method and logistic regression to identify where extra resources and targeted interventions can reduce deaths and improve care for high-risk groups.