Citation: Traoré, A.N.; Rikhotso, M.C.; Banda, N.T.; Mashilo, M.S.; Ngandu, J.P.K.; Mavumengwana, V.; Loxton, A.G.; Kinnear, C.; Potgieter, N.; Heysell, S.; et al. Effectiveness of the Novel Anti-TB Bedaquiline against Drug-Resistant TB in Africa: A Systematic Review of the Literature. Pathogens 2022, 11, 636. https://doi.org/10.3390/ pathogens11060636 Academic Editors: Adrie J.C. Steyn and Lawrence S. Young Received: 29 April 2022 Accepted: 30 May 2022 Published: 1 June 2022 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). pathogens Review Effectiveness of the Novel Anti-TB Bedaquiline against Drug-Resistant TB in Africa: A Systematic Review of the Literature Afsatou Ndama Traoré 1, * , Mpumelelo Casper Rikhotso 1 , Ntshuxeko Thelma Banda 1 , Maphepele Sara Mashilo 1 , Jean Pierre Kabue Ngandu 1 , Vuyo Mavumengwana 2 , Andre G. Loxton 2 , Craig Kinnear 2,3 , Natasha Potgieter 1 , Scott Heysell 4 and Rob Warren 2 1 Department of Biochemistry and Microbiology, Faculty of Sciences, Engineering & Agriculture, University of Venda, Thohoyandou 0950, South Africa; mputso@yahoo.com (M.C.R.); ntshunxeko@gmail.com (N.T.B.); leratomashilo8@gmail.com (M.S.M.); kabue.ngandu@univen.ac.za (J.P.K.N.); natasha.potgieter@univen.ac.za (N.P.) 2 DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa; vuyom@sun.ac.za (V.M.); gl2@sun.ac.za (A.G.L.); gkin@sun.ac.za (C.K.); rw1@sun.ac.za (R.W.) 3 South African Medical Research Council Genomics Centre, Cape Town 7505, South Africa 4 Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, VA 22903, USA; skh8r@hscmail.mcc.virginia.edu * Correspondence: afsatou.traore@univen.ac.za Abstract: Background: In 2018, an estimated 10.0 million people contracted tuberculosis (TB), and 1.5 million died from it, including 1.25 million HIV-negative persons and 251,000 HIV-associated TB fatalities. Drug-resistant tuberculosis (DR-TB) is an important contributor to global TB mortality. Multi-drug-resistant TB (MDR-TB) is defined as TB resistant to at least isoniazid (INH) and rifampin (RMP), which are recommended by the WHO as essential drugs for treatment. Objective: To investi- gate the effectiveness of bedaquiline addition to the treatment of drug-resistant TB infections on the African continent. Methodology: The search engine databases Medline, PubMed, Google Scholar, and Embase were used to obtain published data pertaining to DR-TB between 2012 and 2021 in Africa. Included studies had to document clinical characteristics at treatment initiation and outcomes at the end of treatment (i.e., success, failure, recurrence, loss to follow-up, and death). The included studies were used to conduct a meta-analysis. All data analysis and visualization were performed using the R programming environment. The log risk ratios and sample variances were calculated for DR-TB patients treated with BBQ monotherapy vs. BDQ and other drug therapy. To quantify heterogeneity among the included studies, random effect sizes were calculated. Results: A total of 16 studies in Africa from Mozambique (N = 1 study), Eswatini (N = 1 study), Democratic Republic of the Congo (N = 1 study), South Africa (N = 12 studies), and a multicenter study undertaken across Africa (N = 1 study) were included. In total, 22,368 individuals participated in the research studies. Among the patients, (55.2%; 12,350/22,368) were male while 9723/22,368 (44%) were fe- male. Overall, (9%; 2033/22,368) of patients received BDQ monotherapy, while (88%; 19,630/22,368) patients received bedaquiline combined with other antibiotics. In total, (42%; 9465/22,368) of the patients were successfully treated. About (39%; 8653/22,368) of participants finished their therapy, meanwhile (5%; 1166/22,368) did not finish their therapy, while people (0.4%; 99/22,368) were lost to follow up. A total of (42%; 9265/22,368) patients died. Conclusion: Very few studies on bedaquiline usage in DR-TB in Africa have been published to date. Bedaquiline has been shown to enhance DR-TB results in clinical studies and programmatic settings. Hence, the World Health Organization (WHO) has recommended that it be included in DR-TB regimens. However, in the current study limited improvement to DR-TB treatment results were observed using BDQ on the continent. Better in-country monitoring and reporting, as well as multi-country collaborative cohort studies of DR-TB, can expand the knowledge of bedaquiline usage and clinical impact, as well as the risks and benefits throughout the continent. Pathogens 2022, 11, 636. https://doi.org/10.3390/pathogens11060636 https://www.mdpi.com/journal/pathogens