Comparative Treatment Outcomes of Shorter Regimen in Modified All Oral Regimen with Injectable in Patients Treated for Rifampicin-resistant/Multidrug-resistant Tuberculosis in Tanzania

BACKGROUND: Drug-resistant tuberculosis (TB), especially rifampicin-resistant/multidrug-resistant TB (RR/MDR-TB), remains difficult to treat due to toxic aminoglycosides. The World Health Organization recommended all-oral bedaquiline-based regimens, but evidence comparing their effectiveness to injectable-containing regimens is limited. This study evaluated treatment success between both approaches. METHODS: This was a retrospective study, which included 114 adults aged 18 years and above with RR/MDR-TB treated at Kibong'oto Infectious Diseases Hospital with either a 9-11-month injectable-containing regimen from 2018 to 2019 or a modified all-oral bedaquiline regimen from June 2020 to May 2021. Patients were followed monthly for smear/culture conversion and clinical outcomes up to 12 months posttreatment. Analysis was performed using SPSS version 25. RESULTS: Of 114 patients, 71 (62.3%) received an all-oral bedaquiline-containing regimen. Overall, 80 (70.2%) patients were male, with a median age of 37 years (interquartile range: 29-48); 27 (23.9%) patients were human immunodeficiency virus infected, and 37 (22.5%) had prior TB treatment. Culture conversion at month 2 occurred in all 43 patients on injectable regimens, compared to 63 (90%) patients on all-oral regimens (P = 0.03). Treatment success was higher in the all-oral group at 63 (94.4%), compared to 33 (76.7%) in the injectable group (P = 0.001). Mortality was 7 (14.0%) in the injectable group and 4 (5.6%) in the all-oral group (P = 0.004). CONCLUSION: All-oral bedaquiline regimens demonstrated higher treatment success and lower 12-month posttreatment mortality, while injectable regimens had faster culture conversion at month 2, but poorer overall outcomes, supporting the use of all-oral treatment.