Nazir Ahmed Ismail1, Lindiwe Mvusi2, Ananta Nanoo3, Andries Dreyer3, Shaheed V Omar3, Sanni Babatunde4, Thabo Molebatsi2, Martie van der Walt5, Adeboye Adelekan6, Varough Deyde6, Chikwe Ihekweazu3, Shabir A Madhi7. 1. National Institute for Communicable Diseases, Johannesburg, South Africa; Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa. Electronic address: nazir.ismail@gmail.com. 2. National Department of Health, Tuberculosis Cluster, Pretoria, South Africa. 3. National Institute for Communicable Diseases, Johannesburg, South Africa. 4. World Health Organization-South Africa Mission, Pretoria, South Africa. 5. Medical Research Council, Tuberculosis Platform, Pretoria, South Africa. 6. Centers for Disease Control and Prevention South Africa, Pretoria, South Africa. 7. National Institute for Communicable Diseases, Johannesburg, South Africa; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Department of Science/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa.
Abstract
BACKGROUND: Globally, per-capita, South Africa reports a disproportionately high number of cases of multidrug-resistant (MDR) tuberculosis and extensively drug-resistant (XDR) tuberculosis. We sought to estimate the prevalence of resistance to tuberculosis drugs in newly diagnosed and retreated patients with tuberculosis provincially and nationally, and compared these with the 2001-02 estimates. METHODS: A cross-sectional survey was done between June 15, 2012-June 14, 2014, using population proportionate randomised cluster sampling in the nine provinces in South Africa. 343 clusters were included, ranging between 31 and 48 per province. A patient was eligible for inclusion in the survey if he or she presented as a presumptive case during the intake period at a drug resistance survey enrolling facility. Consenting participants (≥18 years old) completed a questionnaire and had a sputum sample tested for resistance to first-line and second-line drugs. Analysis was by logistic regression with robust SEs, inverse probability weighted against routine data, and estimates were derived using a random effects model. FINDINGS: 101 422 participants were tested in 2012-14. Nationally, the prevalence of MDR tuberculosis was 2·1% (95% CI 1·5-2·7) among new tuberculosis cases and 4·6% (3·2-6·0) among retreatment cases. The provincial point prevalence of MDR tuberculosis ranged between 1·6% (95% CI 0·9-2·9) and 5·1% (3·7-7·0). Overall, the prevalence of rifampicin-resistant tuberculosis (4·6%, 95% CI 3·5-5·7) was higher than the prevalence of MDR tuberculosis (2·8%, 2·0-3·6; p=0·01). Comparing the current survey with the previous (2001-02) survey, the overall MDR tuberculosis prevalence was 2·8% versus 2·9% and prevalance of rifampicin-resistant tuberculosis was 3·4% versus 1·8%, respectively. The prevalence of isoniazid mono-resistant tuberculosis was above 5% in all provinces. The prevalence of ethionamide and pyrazinamide resistance among MDR tuberculosis cases was 44·7% (95% CI 25·9-63·6) and 59·1% (49·0-69·1), respectively. The prevalence of XDR tuberculosis was 4·9% (95% CI 1·0-8·8). Nationally, the estimated numbers of cases of rifampicin-resistant tuberculosis, MDR tuberculosis, and isoniazid mono-resistant tuberculosis for 2014 were 13 551, 8249, and 17 970, respectively. INTERPRETATION: The overall prevalence of MDR tuberculosis in South Africa in 2012-14 was similar to that in 2001-02; however, prevalence of rifampicin-resistant tuberculosis almost doubled among new cases. Furthermore, the high prevalence of isoniazid mono-resistant tuberculosis, not routinely screened for, and resistance to second-line drugs has implications for empirical management. FUNDING: President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention under the terms of 1U19GH000571.
BACKGROUND: Globally, per-capita, South Africa reports a disproportionately high number of cases of multidrug-resistant (MDR) tuberculosis and extensively drug-resistant (XDR) tuberculosis. We sought to estimate the prevalence of resistance to tuberculosis drugs in newly diagnosed and retreated patients with tuberculosis provincially and nationally, and compared these with the 2001-02 estimates. METHODS: A cross-sectional survey was done between June 15, 2012-June 14, 2014, using population proportionate randomised cluster sampling in the nine provinces in South Africa. 343 clusters were included, ranging between 31 and 48 per province. A patient was eligible for inclusion in the survey if he or she presented as a presumptive case during the intake period at a drug resistance survey enrolling facility. Consenting participants (≥18 years old) completed a questionnaire and had a sputum sample tested for resistance to first-line and second-line drugs. Analysis was by logistic regression with robust SEs, inverse probability weighted against routine data, and estimates were derived using a random effects model. FINDINGS: 101 422 participants were tested in 2012-14. Nationally, the prevalence of MDR tuberculosis was 2·1% (95% CI 1·5-2·7) among new tuberculosis cases and 4·6% (3·2-6·0) among retreatment cases. The provincial point prevalence of MDR tuberculosis ranged between 1·6% (95% CI 0·9-2·9) and 5·1% (3·7-7·0). Overall, the prevalence of rifampicin-resistant tuberculosis (4·6%, 95% CI 3·5-5·7) was higher than the prevalence of MDR tuberculosis (2·8%, 2·0-3·6; p=0·01). Comparing the current survey with the previous (2001-02) survey, the overall MDR tuberculosis prevalence was 2·8% versus 2·9% and prevalance of rifampicin-resistant tuberculosis was 3·4% versus 1·8%, respectively. The prevalence of isoniazid mono-resistant tuberculosis was above 5% in all provinces. The prevalence of ethionamide and pyrazinamide resistance among MDR tuberculosis cases was 44·7% (95% CI 25·9-63·6) and 59·1% (49·0-69·1), respectively. The prevalence of XDR tuberculosis was 4·9% (95% CI 1·0-8·8). Nationally, the estimated numbers of cases of rifampicin-resistant tuberculosis, MDR tuberculosis, and isoniazid mono-resistant tuberculosis for 2014 were 13 551, 8249, and 17 970, respectively. INTERPRETATION: The overall prevalence of MDR tuberculosis in South Africa in 2012-14 was similar to that in 2001-02; however, prevalence of rifampicin-resistant tuberculosis almost doubled among new cases. Furthermore, the high prevalence of isoniazid mono-resistant tuberculosis, not routinely screened for, and resistance to second-line drugs has implications for empirical management. FUNDING: President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention under the terms of 1U19GH000571.
Authors: Karen R Jacobson; Danie Theron; Thomas C Victor; Elizabeth M Streicher; Robin M Warren; Megan B Murray Journal: Clin Infect Dis Date: 2011-08 Impact factor: 9.079
Authors: Jakko van Ingen; Rob E Aarnoutse; Peter R Donald; Andreas H Diacon; Rodney Dawson; Georgette Plemper van Balen; Stephen H Gillespie; Martin J Boeree Journal: Clin Infect Dis Date: 2011-05 Impact factor: 9.079
Authors: N Ndjeka; F Conradie; K Schnippel; J Hughes; N Bantubani; H Ferreira; G Maartens; D Mametja; G Meintjes; X Padanilam; E Variava; A Pym; Y Pillay Journal: Int J Tuberc Lung Dis Date: 2015-08 Impact factor: 2.373
Authors: M Sanders; A Van Deun; D Ntakirutimana; J P Masabo; J Rukundo; L Rigouts; K Fissette; F Portaelst Journal: Int J Tuberc Lung Dis Date: 2006-02 Impact factor: 2.373
Authors: Marisa Klopper; Robin Mark Warren; Cindy Hayes; Nicolaas Claudius Gey van Pittius; Elizabeth Maria Streicher; Borna Müller; Frederick Adriaan Sirgel; Mamisa Chabula-Nxiweni; Ebrahim Hoosain; Gerrit Coetzee; Paul David van Helden; Thomas Calldo Victor; André Phillip Trollip Journal: Emerg Infect Dis Date: 2013-03 Impact factor: 6.883
Authors: Karla Therese L Sy; Sarah V Leavitt; Margaretha de Vos; Tania Dolby; Jacob Bor; C Robert Horsburgh; Robin M Warren; Elizabeth M Streicher; Helen E Jenkins; Karen R Jacobson Journal: Sci Rep Date: 2022-06-27 Impact factor: 4.996
Authors: Collins Timire; John Z Metcalfe; Joconiah Chirenda; Jerod N Scholten; Barbara Manyame-Murwira; Mkhokheli Ngwenya; Ronnie Matambo; Kelvin Charambira; Herbert Mutunzi; Nico Kalisvaart; Charles Sandy Journal: Int J Infect Dis Date: 2019-07-27 Impact factor: 12.074
Authors: Nomonde R Mvelase; Melendhran Pillay; Wilbert Sibanda; Jacqueline N Ngozo; James C M Brust; Koleka P Mlisana Journal: Open Forum Infect Dis Date: 2019-02-12 Impact factor: 3.835
Authors: Anna S Dean; Matteo Zignol; Andrea Maurizio Cabibbe; Dennis Falzon; Philippe Glaziou; Daniela Maria Cirillo; Claudio U Köser; Lice Y Gonzalez-Angulo; Olga Tosas-Auget; Nazir Ismail; Sabira Tahseen; Maria Cecilia G Ama; Alena Skrahina; Natavan Alikhanova; S M Mostofa Kamal; Katherine Floyd Journal: PLoS Med Date: 2020-01-21 Impact factor: 11.069