Abstract
BackgroundDetection of tuberculosis disease (TB) and timely identification of Mycobacterium tuberculosis (Mtb) strains that are resistant to treatment are key to halting tuberculosis transmission, improving treatment outcomes, and reducing mortality.MethodsWe used 332,657 Xpert MTB/RIF assay results, captured as part of the Myanmar Data Utilization Project, to characterize Mtb test positivity and rifampicin resistance by both age and sex, and to evaluate risk factors associated with rifampicin resistance.ResultsOverall, 70% of individuals diagnosed with TB were males. Test positivity was higher among males (47%) compared to females (39%). The highest positivity by age occurred among individuals aged 16–20, with test positivity for females (65%) higher than for males (57%). Although a greater absolute number of males were rifampicin resistant, a greater proportion of females (11.4%) were rifampicin resistant as compared to males (9.3%). In the multivariate model, history of previous treatment, age less than 30, testing in the Yangon region, and female sex were significantly positively associated with rifampicin resistance after adjusting for HIV status and year test was performed.ConclusionsOur results indicate that young adults were more likely to test positive for TB and be identified as rifampicin resistant compared to older adults.
Highlights
Detection of tuberculosis disease (TB) and timely identification of Mycobacterium tuberculosis (Mtb) strains that are resistant to treatment are key to halting tuberculosis transmission, improving treatment outcomes, and reducing mortality
There is less consensus regarding other risk factors associated with resistant disease, and while multiple studies indicate that female sex [7, 8, 10] and younger age [6, 7, 11] are associated with increased risk of multi-drug resistant TB (MDRTB), other studies demonstrate that older age [12] and male sex [13, 14] are associated with increased risk of resistance
Because data were captured as deployment sites were being added to the project, the number of individuals tested each year using Xpert MTB/RIF tripled during the course of the project, increasing from 42,327 in 2015 to 122,724 in 2018
Summary
Detection of tuberculosis disease (TB) and timely identification of Mycobacterium tuberculosis (Mtb) strains that are resistant to treatment are key to halting tuberculosis transmission, improving treatment outcomes, and reducing mortality. There is less consensus regarding other risk factors associated with resistant disease, and while multiple studies indicate that female sex [7, 8, 10] and younger age [6, 7, 11] are associated with increased risk of MDRTB, other studies demonstrate that older age [12] and male sex [13, 14] are associated with increased risk of resistance This lack of granular country-level data of both age and sex distribution of disease continues to hamper programmatic targeting for both Mtb case finding and resistance detection
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