Treatment Outcomes for Drug-Resistant Tuberculosis Patients on Bedaquiline-Based Regimens in a Mostly Rural South Africa

Background: Tuberculosis (TB) has maintained its position as a leading global health crisis. The situation of DR-TB is exacerbated by the emergence of drug resistance, particularly rifampicin resistant TB (RR-TB), multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB). Bedaquiline (BDQ) has now become part of all standard drug-resistant regimens globally. However, emerging BDQ resistance is a growing worry, especially in areas with high rates of TB and HIV. This study aimed to compare BDQ-based regimens to non-BDQ-based treatments over a four-year period (2016-2019) to retrospectively examine the treatment outcomes of DR-TB patients in Limpopo Province, South Africa. Methodology: Using patient data from the Limpopo Province Electronic Drug-resistant TB Register (EDR) Web, a retrospective study was carried out. The study comprised 1,665 DR-TB patients; 880 (52.8%) of them were given BDQ-based regimens, whereas 785 (47.2%) were given non-BDQ regimens. Treatment success, death, loss to follow-up, and six-month sputum culture conversion were important outcomes. Kaplan-Meier survival analysis was used to assess the data for mortality, chi-square tests were used for categorical comparisons, and logistic regression models were used to find treatment success predictors. Results: The results of the analysis showed that the BDQ cohort had far better treatment success rates 560/785 (71%) than the non-BDQ cohort 549/880 (62%). Patients receiving BDQ had a reduced overall death rate and quicker sputum culture conversion at six months 608/785 (77.5%) vs 597/880 (67.8%). Kaplan-Meier curve survival analysis revealed a statistically significant survival benefit. Age, HIV status, and BDQ use were found to be significant determinants of treatment effectiveness using logistic regression. Conclusion: In South Africa's mostly rural areas, BDQ-containing regimens proved to be more effective in enhancing treatment outcomes and lowering mortality rates for DR-TB patients. But to keep TB treatment regimens successful, comprehensive drug susceptibility testing and ongoing surveillance are required considering the growing concern over BDQ resistance.