SETTING: Botswana, southern Africa, where the tuberculosis (TB) case rate increased by 120% from 1989 to 1996 in spite of a decade of implementation of the directly observed therapy, short-course (DOTS) strategy. OBJECTIVE: To determine prevalence of and risk factors for drug-resistant tuberculosis in an epidemic setting. DESIGN: Systematic national random survey of newly diagnosed pulmonary TB and all patients with TB requiring retreatment during 1995-1996. Interviews were conducted, human immunodeficiency virus (HIV) testing was offered, and drug susceptibility testing was performed for isoniazid, rifampicin, streptomycin and ethambutol. RESULTS: Resistance to at least one drug was identified in 16 (3.7%) new cases and 18 (14.9%) retreatment cases. One (0.2%) new and seven (5.8%) retreatment cases had resistance to at least both isoniazid and rifampicin (multidrug-resistant TB). Retreatment cases with multidrug-resistant TB were significantly more likely to have worked in the mines in South Africa than were cases with fully susceptible isolates (6/7 [85.7%] versus 32/ 103 [31.1%], odds ratio 13.3, 95% confidence interval 1.5-311.0, P = 0.007). Of 240 patients tested for HIV, 117 (48.8%) were positive; prevalence was similar among new and retreatment cases, and was not a risk factor for drug resistance in either group. CONCLUSION: During the HIV and TB co-epidemics in sub-Saharan Africa, DOTS may help to control drug-resistant TB. However, the TB case rate can be expected to continue to climb in spite of the implementation of the DOTS strategy.
SETTING: Botswana, southern Africa, where the tuberculosis (TB) case rate increased by 120% from 1989 to 1996 in spite of a decade of implementation of the directly observed therapy, short-course (DOTS) strategy. OBJECTIVE: To determine prevalence of and risk factors for drug-resistant tuberculosis in an epidemic setting. DESIGN: Systematic national random survey of newly diagnosed pulmonary TB and all patients with TB requiring retreatment during 1995-1996. Interviews were conducted, human immunodeficiency virus (HIV) testing was offered, and drug susceptibility testing was performed for isoniazid, rifampicin, streptomycin and ethambutol. RESULTS: Resistance to at least one drug was identified in 16 (3.7%) new cases and 18 (14.9%) retreatment cases. One (0.2%) new and seven (5.8%) retreatment cases had resistance to at least both isoniazid and rifampicin (multidrug-resistant TB). Retreatment cases with multidrug-resistant TB were significantly more likely to have worked in the mines in South Africa than were cases with fully susceptible isolates (6/7 [85.7%] versus 32/ 103 [31.1%], odds ratio 13.3, 95% confidence interval 1.5-311.0, P = 0.007). Of 240 patients tested for HIV, 117 (48.8%) were positive; prevalence was similar among new and retreatment cases, and was not a risk factor for drug resistance in either group. CONCLUSION: During the HIV and TB co-epidemics in sub-Saharan Africa, DOTS may help to control drug-resistant TB. However, the TB case rate can be expected to continue to climb in spite of the implementation of the DOTS strategy.
Authors: H J Menzies; G Moalosi; V Anisimova; V Gammino; C Sentle; M A Bachhuber; E Bile; K Radisowa; O Kachuwaire; J Basotli; T Maribe; R Makombe; J Shepherd; B Kim; T Samandari; S El-Halabi; J Chirenda; K P Cain Journal: Int J Tuberc Lung Dis Date: 2014-09 Impact factor: 2.373
Authors: S C Cavalcante; B Durovni; G L Barnes; F B A Souza; R F Silva; P F Barroso; C I Mohan; A Miller; J E Golub; R E Chaisson Journal: Int J Tuberc Lung Dis Date: 2010-02 Impact factor: 2.373
Authors: Sebastian M Mboma; Rein M G J Houben; Judith R Glynn; Lifted Sichali; Francis Drobniewski; James Mpunga; Paul E M Fine; Neil French; Amelia C Crampin Journal: PLoS One Date: 2013-03-06 Impact factor: 3.240