Efficacy of Bedaquiline in the Management of Multidrug-Resistant Tuberculosis in the Central African Republic

Multidrug-resistant tuberculosis (MDR-TB) poses a major challenge in the Central African Republic (CAR), as the high incidence of tuberculosis and resistance rates to anti-tuberculosis drugs compromise efforts to manage MDR/RR-TB patients. This study evaluates the efficacy of bedaquiline, integrated into the short BPaLM regimen (Bedaquiline-Pretomanid-Linezolid-Moxifloxacin), in 68 patients with MDR-TB or pre-extensively drug-resistant (pre-XDR) TB. Strains from the National Reference Laboratory of Bangui underwent whole-genome sequencing and in silico resistance analysis. Among the participants (mean age: 32 years; 60.29% male), 82.35% had MDR-TB and 4.42% had pre-XDR TB. All strains were sensitive to bedaquiline, with no mutation detected in the atpC gene. Of the 59 patients treated, 57 (96.6%) successfully completed the 9-month protocol, confirmed by a negative culture at month 21. Two deaths, occurring before the start of treatment (due to a drug stockout), were not attributable to the treatment regimen. These results demonstrate exceptional efficacy of bedaquiline in a real-world setting, with a 100% therapeutic success rate among patients who received the treatment. The study underscores the importance of continuous access to medications and supports adopting the BPaLM regimen in CAR to improve MDR/RR-TB management. These findings support the integration of bedaquiline into national strategies, aligned with WHO objectives for tuberculosis elimination.