Fifteen years of rifampicin-resistant TB control in Niger: high countrywide treatment uptake and success

Background Few rifampicin-resistant TB (RR-TB) studies show pre-treatment outcomes and definitive treatment outcomes (accounting for RR-TB re-treatment). Our Niger countrywide study covered 15 years to show the trend of RR-TB diagnoses, time-to-treatment initiation, and pre-and on-treatment attrition (loss to follow-up or death). Methods Retrospective study including all Niger RR-TB patients diagnosed between 2008 and 2022. Results 872 RR-TB patients were diagnosed, 725 (83.1%) started treatment, and 32 required retreatment. Between 2008 and 2013 (phenotypic testing), 2014 and 2018 (regional molecular testing), and 2019 and 2022 (decentralised molecular testing), the annual average first RR-TB treatment initiations increased from 22 to 50 and 85, and the median time to first RR-TB treatment reduced from 260 to 17 and 11 days, by period. Pre-treatment attrition reduced from 34.1% to 12.8% and 12.6%. On-treatment attrition increased from 8.8% to 13.5% and 19.8%. Overall, 81.7% ( N = 725) experienced definitive treatment success. On-treatment attrition was 18.3%, predicted by older age, female gender, low BMI, RR-TB/HIV co-infection, high baseline bacillary load, and treatment initiation between 2019 and 2022. Conclusion In Niger, over 15 years of RR-TB control, pre-treatment attrition reduced over time, reflecting better access to care. Treatment success was high, exceeding global success. However, increasing on-treatment attrition should be addressed by targeting high-risk groups.