{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T09:06:32Z","timestamp":1780131992151,"version":"3.54.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":16,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Tuberculosis Program"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2013Meier functions for time to outcome, and fitted multivariable logistic regression and Cox proportional hazards models to identify predictors of unsuccessful outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 277 DR-TB patients (median age 37 years; 3\u201375), 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\u20130.82; P = .011), whereas retreatment other than relapse was associated with higher odds of unsuccessful outcome (aOR 2.04; 95% CI 1.09\u20133.81; P = .026). Findings were consistent in time-to-event models (rural aHR 0.50; 95% CI 0.29\u20130.85; P = .011; retreatment aHR 1.71; 95% CI 1.03\u20132.83; P = .038).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In a humanitarian crisis context, programmatic all-oral DR-TB care achieved success exceeding the WHO \u2265 75% target. Persistently high mortality and LTFU\u2014concentrated among urban residents and retreatment (non-relapse) cases\u2014highlight 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag303","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T11:55:58Z","timestamp":1778673358000},"source":"Crossref","is-referenced-by-count":0,"title":["Drug-Resistant Tuberculosis Outcomes in South Kivu Province, Democratic Republic of Congo, During a Humanitarian Crisis (2018\u20132024)"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8109-0179","authenticated-orcid":false,"given":"Eric Mulume","family":"Musafiri","sequence":"first","affiliation":[{"name":"National Tuberculosis Program Democratic Republic of the Congo (DRC) Drug Resistance Unit, , Bukavu ,","place":["DRC"]},{"name":"Universit\u00e9 Officielle de Bukavu Department of Medicine, , Bukavu ,","place":["DRC"]},{"name":"Institut Sup\u00e9rieur de Techniques M\u00e9dicales de Kaziba Department of Public Health, , Kaziba ,","place":["DRC"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barhwamire Th\u00e9ophile","family":"Kabesha","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Officielle de Bukavu Department of Medicine, , Bukavu ,","place":["DRC"]},{"name":"Institut Sup\u00e9rieur de Techniques M\u00e9dicales de Kaziba Department of Public Health, , Kaziba ,","place":["DRC"]},{"name":"Facult\u00e9 de M\u00e9decine, Universit\u00e9 Officielle de Bukavu , Bukavu ,","place":["DRC"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Freddy","family":"Birembano","sequence":"additional","affiliation":[{"name":"National Tuberculosis Program Democratic Republic of the Congo (DRC) Drug Resistance Unit, , Bukavu ,","place":["DRC"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosette","family":"Nyota","sequence":"additional","affiliation":[{"name":"National Tuberculosis Program Democratic Republic of the Congo (DRC) Drug Resistance Unit, , Bukavu ,","place":["DRC"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryska Chimanuka","family":"Mapendo","sequence":"additional","affiliation":[{"name":"H\u00f4pital G\u00e9n\u00e9ral de R\u00e9f\u00e9rence de Miti-Murhesa Department of Internal Medicine, , Sud Kivu ,","place":["DRC"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Paul","family":"Chirambiza","sequence":"additional","affiliation":[{"name":"Expertise France, Project RESOH-Lab, Bureau de Bukavu , Bukavu ,","place":["DRC"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tr\u00e9sor Kashinde","family":"Mosomo","sequence":"additional","affiliation":[{"name":"Public Health School of Goma, University of Goma , Goma ,","place":["DRC"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edmond Ntabe","family":"Namegabe","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Libre des Pays de Grands Lacs Department of Medicine, , Goma ,","place":["DRC"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"2026053004512956300_ofag303-B1","author":"WHO"},{"key":"2026053004512956300_ofag303-B2","doi-asserted-by":"crossref","first-page":"S20","DOI":"10.1016\/j.ijid.2022.03.026","article-title":"Drug resistant TB\u2014latest developments in epidemiology, diagnostics and management","volume":"124","author":"Tiberi","year":"2022","journal-title":"Int J Infect Dis"},{"key":"2026053004512956300_ofag303-B3","doi-asserted-by":"publisher","first-page":"5:291\u2013360","DOI":"10.1016\/S2213-2600(17)30079-6","article-title":"The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis","author":"Dheda","year":"2017","journal-title":"Lancet Respir Med"},{"key":"2026053004512956300_ofag303-B4","volume-title":"WHO Bacterial 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