M Ballif1, V Nhandu2, R Wood3, J C Dusingize4, E J Carter5, C P Cortes6, C C McGowan7, L Diero5, C Graber1, L Renner8, D Hawerlander9, S Kiertiburanakul10, Q T Du11, T R Sterling7, M Egger1, L Fenner11. 1. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland. 2. Centre for Infectious Disease Research in Zambia, Lusaka, Zambia. 3. Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa. 4. Women's Equity in Access to Care & Treatment, Kigali, Rwanda. 5. United States Agency for International Development Academic Model Providing Access to Healthcare, Eldoret, Kenya. 6. University of Chile School of Medicine, Santiago, Chile. 7. Vanderbilt University School of Medicine, Nashville, Tennessee, USA. 8. University of Ghana Medical School, Accra, Ghana. 9. Centre Intégré de Recherches Biocliniques, Abidjan, Côte d'Ivoire. 10. Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Children's Hospital, Ho Chi Minh City, Viet Nam. 11. Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland.
Abstract
SETTING: Drug resistance threatens tuberculosis (TB) control, particularly among human immunodeficiency virus (HIV) infected persons. OBJECTIVE: To describe practices in the prevention and management of drug-resistant TB under antiretroviral therapy (ART) programs in lower-income countries. DESIGN: We used online questionnaires to collect program-level data on 47 ART programs in Southern Africa (n = 14), East Africa (n = 8), West Africa (n = 7), Central Africa (n = 5), Latin America (n = 7) and the Asia-Pacific (n = 6 programs) in 2012. Patient-level data were collected on 1002 adult TB patients seen at 40 of the participating ART programs. RESULTS: Phenotypic drug susceptibility testing (DST) was available in 36 (77%) ART programs, but was only used for 22% of all TB patients. Molecular DST was available in 33 (70%) programs and was used in 23% of all TB patients. Twenty ART programs (43%) provided directly observed therapy (DOT) during the entire course of treatment, 16 (34%) during the intensive phase only, and 11 (23%) did not follow DOT. Fourteen (30%) ART programs reported no access to second-line anti-tuberculosis regimens; 18 (38%) reported TB drug shortages. CONCLUSIONS: Capacity to diagnose and treat drug-resistant TB was limited across ART programs in lower-income countries. DOT was not always implemented and drug supplies were regularly interrupted, which may contribute to the global emergence of drug resistance.
SETTING: Drug resistance threatens tuberculosis (TB) control, particularly among humanimmunodeficiency virus (HIV) infectedpersons. OBJECTIVE: To describe practices in the prevention and management of drug-resistant TB under antiretroviral therapy (ART) programs in lower-income countries. DESIGN: We used online questionnaires to collect program-level data on 47 ART programs in Southern Africa (n = 14), East Africa (n = 8), West Africa (n = 7), Central Africa (n = 5), Latin America (n = 7) and the Asia-Pacific (n = 6 programs) in 2012. Patient-level data were collected on 1002 adult TB patients seen at 40 of the participating ART programs. RESULTS: Phenotypic drug susceptibility testing (DST) was available in 36 (77%) ART programs, but was only used for 22% of all TB patients. Molecular DST was available in 33 (70%) programs and was used in 23% of all TB patients. Twenty ART programs (43%) provided directly observed therapy (DOT) during the entire course of treatment, 16 (34%) during the intensive phase only, and 11 (23%) did not follow DOT. Fourteen (30%) ART programs reported no access to second-line anti-tuberculosis regimens; 18 (38%) reported TB drug shortages. CONCLUSIONS: Capacity to diagnose and treat drug-resistant TB was limited across ART programs in lower-income countries. DOT was not always implemented and drug supplies were regularly interrupted, which may contribute to the global emergence of drug resistance.
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