Abstract
BackgroundMultidrug resistant and extensively drug resistant tuberculosis (TB) have become major threats to control of tuberculosis globally. The rates of anti-TB drug resistance in Uganda are not known. We conducted a national drug resistance survey to investigate the levels and patterns of resistance to first and second line anti-TB drugs among new and previously treated sputum smear-positive TB cases.MethodsSputum samples were collected from a nationally representative sample of new and previously treated sputum smear-positive TB patients registered at TB diagnostic centers during December 2009 to February 2011 using a weighted cluster sampling method. Culture and drug susceptibility testing was performed at the national TB reference laboratory.ResultsA total of 1537 patients (1397 new and 140 previously treated) were enrolled in the survey from 44 health facilities. HIV test result and complete drug susceptibility testing (DST) results were available for 1524 (96.8%) and 1325 (85.9%) patients, respectively. Of the 1209 isolates from new cases, resistance to any anti-TB drug was 10.3%, 5% were resistant to isoniazid, 1.9% to rifampicin, and 1.4% were multi drug resistant. Among the 116 isolates from previously treated cases, the prevalence of resistance was 25.9%, 23.3%, 12.1% and 12.1% respectively. Of the 1524 patients who had HIV testing 469 (30.7%) tested positive. There was no association between anti-TB drug resistance (including MDR) and HIV infection.ConclusionThe prevalence of anti-TB drug resistance among new patients in Uganda is low relative to WHO estimates. The higher levels of MDR-TB (12.1%) and resistance to any drug (25.3%) among previously treated patients raises concerns about the quality of directly observed therapy (DOT) and adherence to treatment. This calls for strengthening existing TB control measures, especially DOT, routine DST among the previously treated TB patients or periodic drug resistance surveys, to prevent and monitor development and transmission of drug resistant TB.
Highlights
Tuberculosis (TB) remains one of the world’s leading causes of adult morbidity and mortality resulting in an estimated 8.8 million incident cases and 1.4 million deaths in 2010
The STOP TB strategy developed by the World Health Organization (WHO) aims to dramatically reduce the global burden of tuberculosis by 2015 by ensuring that all TB patients benefit from universal access to high-quality diagnosis and patientcentered treatment [2]
The emergence of extensively drug resistant (XDR) TB, that is MDRTB strains resistant to any fluoroquinolone and at least one of three injectable second-line drugs and its association with high mortality among people living with HIV has raised a new challenge for TB control [13]
Summary
Tuberculosis (TB) remains one of the world’s leading causes of adult morbidity and mortality resulting in an estimated 8.8 million incident cases and 1.4 million deaths in 2010. SubSaharan Africa (SSA), a region with highest incidence of TB in the world hosts nine of the highest TB incidence countries globally [1]. The STOP TB strategy developed by the World Health Organization (WHO) aims to dramatically reduce the global burden of tuberculosis by 2015 by ensuring that all TB patients benefit from universal access to high-quality diagnosis and patientcentered treatment [2]. Multidrug resistant and extensively drug resistant tuberculosis (TB) have become major threats to control of tuberculosis globally. The rates of anti-TB drug resistance in Uganda are not known. We conducted a national drug resistance survey to investigate the levels and patterns of resistance to first and second line anti-TB drugs among new and previously treated sputum smear-positive TB cases
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