Aditya Sharma1, Andrew Hill2, Ekaterina Kurbatova2, Martie van der Walt3, Charlotte Kvasnovsky4, Thelma E Tupasi5, Janice C Caoili5, Maria Tarcela Gler5, Grigory V Volchenkov6, Boris Y Kazennyy7, Olga V Demikhova8, Jaime Bayona9, Carmen Contreras9, Martin Yagui10, Vaira Leimane11, Sang Nae Cho12, Hee Jin Kim13, Kai Kliiman14, Somsak Akksilp15, Ruwen Jou16, Julia Ershova2, Tracy Dalton2, Peter Cegielski2. 1. US Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: asharma4@cdc.gov. 2. US Centers for Disease Control and Prevention, Atlanta, GA, USA. 3. South Africa Medical Research Council, Pretoria, South Africa. 4. University of Maryland Medical Center, Baltimore, MD, USA. 5. Tropical Disease Foundation, Manila, Philippines. 6. Vladimir Oblast Tuberculosis Dispensary, Vladimir, Russia. 7. Orel Oblast Tuberculosis Dispensary, Orel, Russia. 8. Central Tuberculosis Research Institute, Russian Academy of Medical Sciences, Moscow, Russia. 9. Socios en Salud Sucursal, Lima, Peru. 10. National Institute of Health, Lima, Peru. 11. Riga East University Hospital Centre of Tuberculosis and Lung Diseases, Latvia. 12. International Tuberculosis Research Center, Changwon and Yonsei University College of Medicine, Seoul, South Korea. 13. Korean Institute of Tuberculosis, Seoul, South Korea. 14. Tartu University Hospital, Tartu, Estonia. 15. Ministry of Public Health, Bangkok, Thailand. 16. Taiwan Centers for Disease Control, Taipei, Taiwan.
Abstract
BACKGROUND: Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis are emerging worldwide. The Green Light Committee initiative supported programmatic management of drug-resistant tuberculosis in 90 countries. We used estimates from the Preserving Effective TB Treatment Study to predict MDR and XDR tuberculosis trends in four countries with a high burden of MDR tuberculosis: India, the Philippines, Russia, and South Africa. METHODS: We calibrated a compartmental model to data from drug resistance surveys and WHO tuberculosis reports to forecast estimates of incident MDR and XDR tuberculosis and the percentage of incident MDR and XDR tuberculosis caused by acquired drug resistance, assuming no fitness cost of resistance from 2000 to 2040 in India, the Philippines, Russia, and South Africa. FINDINGS: The model forecasted the percentage of MDR tuberculosis among incident cases of tuberculosis to increase, reaching 12·4% (95% prediction interval 9·4-16·2) in India, 8·9% (4·5-11·7) in the Philippines, 32·5% (27·0-35·8) in Russia, and 5·7% (3·0-7·6) in South Africa in 2040. It also predicted the percentage of XDR tuberculosis among incident MDR tuberculosis to increase, reaching 8·9% (95% prediction interval 5·1-12·9) in India, 9·0% (4·0-14·7) in the Philippines, 9·0% (4·8-14·2) in Russia, and 8·5% (2·5-14·7) in South Africa in 2040. Acquired drug resistance would cause less than 30% of incident MDR tuberculosis during 2000-40. Acquired drug resistance caused 80% of incident XDR tuberculosis in 2000, but this estimate would decrease to less than 50% by 2040. INTERPRETATION: MDR and XDR tuberculosis were forecast to increase in all four countries despite improvements in acquired drug resistance shown by the Green Light Committee-supported programmatic management of drug-resistant tuberculosis. Additional control efforts beyond improving acquired drug resistance rates are needed to stop the spread of MDR and XDR tuberculosis in countries with a high burden of MDR tuberculosis. FUNDING: US Agency for International Development and US Centers for Disease Control and Prevention, Division of Tuberculosis Elimination.
BACKGROUND: Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis are emerging worldwide. The Green Light Committee initiative supported programmatic management of drug-resistant tuberculosis in 90 countries. We used estimates from the Preserving Effective TB Treatment Study to predict MDR and XDR tuberculosis trends in four countries with a high burden of MDR tuberculosis: India, the Philippines, Russia, and South Africa. METHODS: We calibrated a compartmental model to data from drug resistance surveys and WHO tuberculosis reports to forecast estimates of incident MDR and XDR tuberculosis and the percentage of incident MDR and XDR tuberculosis caused by acquired drug resistance, assuming no fitness cost of resistance from 2000 to 2040 in India, the Philippines, Russia, and South Africa. FINDINGS: The model forecasted the percentage of MDR tuberculosis among incident cases of tuberculosis to increase, reaching 12·4% (95% prediction interval 9·4-16·2) in India, 8·9% (4·5-11·7) in the Philippines, 32·5% (27·0-35·8) in Russia, and 5·7% (3·0-7·6) in South Africa in 2040. It also predicted the percentage of XDR tuberculosis among incident MDR tuberculosis to increase, reaching 8·9% (95% prediction interval 5·1-12·9) in India, 9·0% (4·0-14·7) in the Philippines, 9·0% (4·8-14·2) in Russia, and 8·5% (2·5-14·7) in South Africa in 2040. Acquired drug resistance would cause less than 30% of incident MDR tuberculosis during 2000-40. Acquired drug resistance caused 80% of incident XDR tuberculosis in 2000, but this estimate would decrease to less than 50% by 2040. INTERPRETATION: MDR and XDR tuberculosis were forecast to increase in all four countries despite improvements in acquired drug resistance shown by the Green Light Committee-supported programmatic management of drug-resistant tuberculosis. Additional control efforts beyond improving acquired drug resistance rates are needed to stop the spread of MDR and XDR tuberculosis in countries with a high burden of MDR tuberculosis. FUNDING: US Agency for International Development and US Centers for Disease Control and Prevention, Division of Tuberculosis Elimination.
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