Epidemiology and outcomes of multidrug-resistant tuberculosis in Rwanda

• MDR-TB prevalence in Rwanda was 0.96%, with high treatment success (93.5%). • GeneXpert tests achieved 92.9% sensitivity for rifampicin and isoniazid resistance. • Mortality was associated with HIV co-infection and malnutrition (BMI < 18.5 kg/m 2 ). Multidrug-resistant tuberculosis (MDR-TB) is a significant public health challenge in Rwanda. This retrospective study aimed to describe the epidemiological characteristics, diagnostic approaches, and treatment outcomes of MDR-TB cases between July 1, 2019 and June 30, 2023. Among 23,476 tuberculosis cases diagnosed in Rwanda, 227 (0.96 %) were confirmed as MDR-TB. Key findings include male predominance (80.6 %) and a mean age of 39.6 years. Pulmonary tuberculosis accounted for 96.9 % of cases, and 20.3 % of patients were co-infected with HIV. The GeneXpert molecular diagnostic test − the first-line diagnostic tool − demonstrated a sensitivity of 92.9 % for detecting resistance to rifampicin and isoniazid. The overall therapeutic success rate was 93.5 %, with a mortality rate of 5.3 % in evaluable cases (82.4 %). Risk factors for mortality included HIV co-infection and malnutrition (BMI < 18.5 kg/m 2 ). These findings underscore the importance of robust diagnostic and treatment strategies to control MDR-TB in Rwanda.