Brian Barnett1, Runa H Gokhale2, Robert Krysiak2, Creto Kanyemba2, Tarsizio Chikaonda2, Mphatso Bokosi3, Cornelius Mukuzunga2, Friday Saidi2, Sam Phiri3, Irving F Hoffman4, Mina C Hosseinipour5. 1. University of North Carolina Project, Lilongwe, Malawi Vanderbilt University School of Medicine, Nashville, Tennessee, United States bbarnett@partners.org. 2. University of North Carolina Project, Lilongwe, Malawi. 3. Light House Clinic Trust, Lilongwe, Malawi. 4. Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States. 5. University of North Carolina Project, Lilongwe, Malawi Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.
Abstract
BACKGROUND: We sought to determine the prevalence of drug resistant TB among outpatients initiating TB treatment in Lilongwe, Malawi. METHODS: This was a prospective cohort study of patients 18 years and older initiating TB treatment at Martin Preuss Centre, the primary integrated HIV/TB clinic in Lilongwe, Malawi, from April 2011 to July 2012. Procedures included questionnaires, physical exam, chest x-ray, full blood count and sputum collection. Sputum samples underwent acid-fast bacilli (AFB) smear testing and culture by Lowenstein-Jensen (LJ) and liquid Mycobacteria Growth Indicator Tube (MGIT) methods. Drug sensitivity was investigated using the Hain GenoType MTBDRplus line probe assay. RESULTS: Of the 702 patients, 219 (31.2%) were female and 653 (93.0%) were presenting for first-time TB treatment. HIV co-infection was present in 420 (59.8%) cases, with 137 (32.6%) of those patients receiving antiretroviral therapy at presentation. TB was culture-confirmed in 375 (53.4%) patients, 349 of which were first time treatment and 26 retreatment. Ten cases of isoniazid-resistant TB (2.9% of culture confirmed cases of newly treated TB), one of rifampin-resistant TB (0.3% culture confirmed cases of newly treated TB) and one of multi-drug resistant TB (MDR-TB) (3.8% of culture confirmed cases of retreatment TB) were detected. CONCLUSIONS: MDR-TB prevalence is low among outpatients initiating TB treatment in Lilongwe.
BACKGROUND: We sought to determine the prevalence of drug resistant TB among outpatients initiating TB treatment in Lilongwe, Malawi. METHODS: This was a prospective cohort study of patients 18 years and older initiating TB treatment at Martin Preuss Centre, the primary integrated HIV/TB clinic in Lilongwe, Malawi, from April 2011 to July 2012. Procedures included questionnaires, physical exam, chest x-ray, full blood count and sputum collection. Sputum samples underwent acid-fast bacilli (AFB) smear testing and culture by Lowenstein-Jensen (LJ) and liquid Mycobacteria Growth Indicator Tube (MGIT) methods. Drug sensitivity was investigated using the Hain GenoType MTBDRplus line probe assay. RESULTS: Of the 702 patients, 219 (31.2%) were female and 653 (93.0%) were presenting for first-time TB treatment. HIV co-infection was present in 420 (59.8%) cases, with 137 (32.6%) of those patients receiving antiretroviral therapy at presentation. TB was culture-confirmed in 375 (53.4%) patients, 349 of which were first time treatment and 26 retreatment. Ten cases of isoniazid-resistant TB (2.9% of culture confirmed cases of newly treated TB), one of rifampin-resistant TB (0.3% culture confirmed cases of newly treated TB) and one of multi-drug resistant TB (MDR-TB) (3.8% of culture confirmed cases of retreatment TB) were detected. CONCLUSIONS: MDR-TB prevalence is low among outpatients initiating TB treatment in Lilongwe.
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