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Drug Resistant TB

Tanzania decentralized DR-TB treatment initiation sites from one hospital in 2015 to all regions countrywide. The number of Health facilities that has at least initiated treatment to DR-TB patients were 305 in 2023. Tanzania is regarded as a low RR/MDR-TB burden with an annual incidence of 1,300 and as reported in WHO GTR 2024.

Number of people with confirmed RR-TB and /or MDR-TB notified in 2023

The number of RR and/or MDR-TB cases notified increased from 197 in 2015 to 337 in 2023. This is due to scaling up of molecular WHO recommended rapid diagnostic in facilities from 66 in 2015 to 341 in 2023 likewise there is significant increase in proportion of bacteriologically confirmed cases and those with DST at least for Rifampicin resulting from increased access to mWRDs as described above. However, despite increased access to DST the RR/MDR TB notification decreased to 37% of the set target of 909 patients in 2023. This little breakthrough in RR/MDR TB notification could be attributed to sub-optimal sample referral system, uneven distribution of molecular diagnostic technologies, erratic supply of reagents in the country. Nevertheless, the 2023 data shows that the proportion of DR-TB cases among the pulmonary bacteriologically confirmed TB cases for both new and previously treated TB cases has gone down to 0.74% and 7.91% respectively as compared to 2022 data. This imply that the prevalence of DR-TB may be lower than estimated previously hence the need for current DRS to ascertain the current country DR-TB burden.

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Figure 12:Trend number of RR and/or MDR -TB patients notified versus Incidence and Target 2015 – 2023

Number of people with confirmed RR-TB and /or MDR-TB notified by regions in 2023

As illustrated in figure 13 below, 73% of all RR and/MDR TB cases notified and enrolled into treatment in the country were contributed by 16, these regions includes Kinondoni, Ilala I&II, Temeke, Pwani, Shinyanga, Morogoro, Mwanza, Geita, Kigoma Tabora, Dodoma, Kilimanjaro, Arusha, Manyara and Mtwara.  Pemba , Unguja, Mara, Katavi, Kagera and Songwe notified and enrolled into treatment the least number of RR/MDR TB cases in 2023.

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Figure 13: Number of laboratory confirmed RR and/or MDR TB cases notified (source: DHIS2 ETL)

Treatment success rate of RR/MDR-TB patients

As shown in figure 14, there was a decline of treatment success rate from 78% in 2020 to 70% in 2021. This could be due to the existing model of care where by both treatment initiation sites and follow up/DOTs sites are evolving depending notification of DR TB patients. This compromises quality of care as was noted during Program Mid Term Review 2023 it is difficult to continuously build capacity on PMDT for frequently changing facilities where DR-TB patients are initiated treatment. In order to rectify this situation, it was recommended to establish few permanent DR TB Treatment initiation sites and capacity build them for continuous use and quality of care.

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Figure 14:Trend of Treatment Success rate for RR/MDR TB enrolled into treatment 2015 to 2021

Treatment success rate of RR/MDR-TB patients enrolled into treatment in 2021 by regimens

Since 2020 the country introduced modified all oral shorter DR TB regimen under operational research. Use of all oral longer DR TB regimen was used for patients who were not eligible for the shorter regimen or from facilities where the research was not implemented. Of the 2021 cohort, 385 patients had complete information for outcomes and regimen in the DHIS2-ETL where 115 (30%) and 270 (70%) were enrolled in the shorter and longer regimens respectively. Patients enrolled in the modified all oral shorter DR TB regimen had treatment success rate of 86% compared to those on longer regimens which is 73%. The higher success rate among patients on shorter regimen could be attributed to exclusion of serious ill patients or those whom Bedaquiline was contraindicated and monthly virtual progress follow up (Concilium) of the sites enrolling patients on this regimen.

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Figure 15: Treatment outcomes for RR/MDR TB enrolled into shorter and longer regimens in 2021 (Source: DHIS2-ETL)

Treatment success rate by regions for 2021 Cohort

RR/MDR-TB treatment success rate by region for cohort 2021

Figure 16 shows the DR-TB treatment outcome by region for the cohort enrolled into treatment in 2021.; the results indicate that only six regions achieved the treatment success target of 80% However, most of the regions have death rate above 5%, only Kigamboni, Kigoma and Singida regions reported low death rate below 5%.

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Figure 16: DR-TB treatment outcomes by region for 2021 cohort (Source: DHIS2-ETL)