{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:18:12Z","timestamp":1760120292254},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,2,5]],"date-time":"2020-02-05T00:00:00Z","timestamp":1580860800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,2,5]],"date-time":"2020-02-05T00:00:00Z","timestamp":1580860800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001322","name":"South African Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001322","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The Lesotho guidelines for the management of drug-resistant tuberculosis (TB) recommend initiation of patients diagnosed with rifampicin resistant (RR)-TB on a standardized drug resistant regimen while awaiting confirmation of rifampicin resistant TB (RR-TB) and complete drug susceptibility test results. Review of diagnostic records between 2014 and 2016 identified 518 patients with RR-TB. Only 314 (60.6%) patients could be linked to treatment records at the Lesotho MDR hospital. The median delay in treatment initiation from the availability of Xpert MTB\/RIF assay result was 12 days (IQR 7\u201319). Only 32% (101) of patients had a documented first-line drug resistant test. MDR-TB was detected in 56.4% of patients while 33.7% of patients had rifampicin mono-resistance. Only 7.4% of patients assessed for second-line resistance had a positive result (resistance to fluoroquinolone). Treatment success was 69.8%, death rate was 28.8%, loss to follow up was 1.0%, and 0.4% failed treatment. Death was associated with positive or unavailable sputum smear at the end of first month of treatment (Fisher exact p\u2009&lt;\u20090.001) and older age (p\u2009=\u20090.007). Urgent attention needs to be given to link patients with RR-TB to care worldwide. The association of death rate with positive sputum smear at the end of the first month of treatment should trigger early individualization of treatment.<\/jats:p>","DOI":"10.1038\/s41598-020-58690-4","type":"journal-article","created":{"date-parts":[[2020,2,5]],"date-time":"2020-02-05T11:03:18Z","timestamp":1580900598000},"update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Rifampicin Resistant Tuberculosis in Lesotho: Diagnosis, Treatment Initiation and Outcomes"],"prefix":"10.1038","volume":"10","author":[{"given":"Bulemba","family":"Katende","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tonya M.","family":"Esterhuizen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anzaan","family":"Dippenaar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robin M.","family":"Warren","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,2,5]]},"reference":[{"key":"58690_CR1","unstructured":"World Health Organization. Global Tuberculosis Report, 2019. https:\/\/www.who.int\/tb\/publications\/global_report\/en\/"},{"key":"58690_CR2","unstructured":"Lesotho Ministry of Health. Annual Tuberculosis Report 2015. (Lesotho Ministry of Health, Maseru, Lesotho, 2015)."},{"key":"58690_CR3","unstructured":"Lesotho Ministry of Health. Annual Tuberculosis Report 2016. (Lesotho Ministry of Health, Maseru, Lesotho, 2017)."},{"key":"58690_CR4","unstructured":"PEPFAR. Lesotho Country Operational Plan (COP\/ROP), Strategic Direction Summary. https:\/\/www.medbox.org\/ls-policies-hiv-tb\/lesotho-country-operational-plan-coprop-2017-strategic-direction-summary\/preview? (2017)."},{"key":"58690_CR5","doi-asserted-by":"crossref","unstructured":"Steingart, K. R. et al. Xpert(R) MTB\/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database Syst Rev, CD009593, doi:10.1002\/14651858.CD009593.pub3 (2014).","DOI":"10.1002\/14651858.CD009593.pub3"},{"key":"58690_CR6","unstructured":"Lesotho Ministry of Health. National Guidelines for Tuberculosis. (Lesotho Ministry of Health, Maseru, Lesotho, 2016)."},{"key":"58690_CR7","unstructured":"Lesotho Ministry of Health. Annual Tuberculosis Report 2017. (Lesotho Ministry of Health, Maseru, Lesotho, 2018)."},{"key":"58690_CR8","doi-asserted-by":"publisher","first-page":"1502","DOI":"10.1093\/cid\/cix128","volume":"64","author":"KR Jacobson","year":"2017","unstructured":"Jacobson, K. R. et al. Implications of Failure to Routinely Diagnose Resistance to Second-Line Drugs in Patients With Rifampicin-Resistant Tuberculosis on Xpert MTB\/RIF: A Multisite Observational Study. Clin Infect Dis 64, 1502\u20131508, https:\/\/doi.org\/10.1093\/cid\/cix128 (2017).","journal-title":"Clin Infect Dis"},{"key":"58690_CR9","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-017-2200-8","volume":"17","author":"J Iruedo","year":"2017","unstructured":"Iruedo, J., O\u2019Mahony, D., Mabunda, S., Wright, G. & Cawe, B. The effect of the Xpert MTB\/RIF test on the time to MDR-TB treatment initiation in a rural setting: a cohort study in South Africa\u2019s Eastern Cape Province. BMC Infect Dis 17, 91, https:\/\/doi.org\/10.1186\/s12879-017-2200-8 (2017).","journal-title":"BMC Infect Dis"},{"key":"58690_CR10","doi-asserted-by":"publisher","first-page":"e1002238","DOI":"10.1371\/journal.pmed.1002238","volume":"14","author":"H Cox","year":"2017","unstructured":"Cox, H. et al. Delays and loss to follow-up before treatment of drug-resistant tuberculosis following implementation of Xpert MTB\/RIF in South Africa: A retrospective cohort study. PLoS Med 14, e1002238, https:\/\/doi.org\/10.1371\/journal.pmed.1002238 (2017).","journal-title":"PLoS Med"},{"key":"58690_CR11","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-018-3762-x","volume":"18","author":"D Evans","year":"2018","unstructured":"Evans, D. et al. Impact of Xpert MTB\/RIF and decentralized care on linkage to care and drug-resistant tuberculosis treatment outcomes in Johannesburg, South Africa. BMC Health Serv Res 18, 973, https:\/\/doi.org\/10.1186\/s12913-018-3762-x (2018).","journal-title":"BMC Health Serv Res"},{"key":"58690_CR12","doi-asserted-by":"publisher","first-page":"ofv014","DOI":"10.1093\/ofid\/ofv014","volume":"2","author":"HS Cox","year":"2015","unstructured":"Cox, H. S. et al. Impact of Decentralized Care and the Xpert MTB\/RIF Test on Rifampicin-Resistant Tuberculosis Treatment Initiation in Khayelitsha, South Africa. Open Forum Infect Dis 2, ofv014, https:\/\/doi.org\/10.1093\/ofid\/ofv014 (2015).","journal-title":"Open Forum Infect Dis"},{"key":"58690_CR13","unstructured":"World Health Organization. Xpert MTB\/RIF implemenation manual. Technical and operational \u2018how-to\u2019: practical considerations. https:\/\/www.who.int\/tb\/publications\/xpert_implem_manual\/en\/ (Geneva, Switzerland, 2014)."},{"key":"58690_CR14","doi-asserted-by":"publisher","first-page":"e77712","DOI":"10.1371\/journal.pone.0077712","volume":"8","author":"YM Coovadia","year":"2013","unstructured":"Coovadia, Y. M., Mahomed, S., Pillay, M., Werner, L. & Mlisana, K. Rifampicin mono-resistance in Mycobacterium tuberculosis in KwaZulu-Natal, South Africa: a significant phenomenon in a high prevalence TB-HIV region. PLoS One 8, e77712, https:\/\/doi.org\/10.1371\/journal.pone.0077712 (2013).","journal-title":"PLoS One"},{"key":"58690_CR15","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1016\/S1473-3099(18)30222-6","volume":"18","author":"NA Ismail","year":"2018","unstructured":"Ismail, N. A. et al. Prevalence of drug-resistant tuberculosis and imputed burden in South Africa: a national and sub-national cross-sectional survey. Lancet Infect Dis 18, 779\u2013787, https:\/\/doi.org\/10.1016\/S1473-3099(18)30222-6 (2018).","journal-title":"Lancet Infect Dis"},{"key":"58690_CR16","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.1164\/ajrccm.152.3.7663785","volume":"152","author":"CM Nolan","year":"1995","unstructured":"Nolan, C. M. et al. Evolution of rifampin resistance in human immunodeficiency virus-associated tuberculosis. Am J Respir Crit Care Med 152, 1067\u20131071, https:\/\/doi.org\/10.1164\/ajrccm.152.3.7663785 (1995).","journal-title":"Am J Respir Crit Care Med"},{"key":"58690_CR17","doi-asserted-by":"publisher","first-page":"1881","DOI":"10.1164\/ajrccm.157.6.9712009","volume":"157","author":"R Ridzon","year":"1998","unstructured":"Ridzon, R. et al. Risk factors for rifampin mono-resistant tuberculosis. Am J Respir Crit Care Med 157, 1881\u20131884, https:\/\/doi.org\/10.1164\/ajrccm.157.6.9712009 (1998).","journal-title":"Am J Respir Crit Care Med"},{"key":"58690_CR18","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1164\/ajrccm.153.2.8564140","volume":"153","author":"M Lutfey","year":"1996","unstructured":"Lutfey, M. et al. Independent origin of mono-rifampin-resistant Mycobacterium tuberculosis in patients with AIDS. 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