Abstract
Tuberculosis (TB) is a global outbreak whose drug resistance is a constant threat. This study aimed at describing anti-TB drugs resistance and treatment outcomes among retreatment TB patients in Guinea between 2008 and 2012. We conducted a retrospective cohort study with a sample of 558 patients aged of at least 10, who were admitted for TB retreatment and who were tested for anti-TB drugs susceptibility during the study period. Overall, 3187 retreatment TB patients were recorded from January 1, 2008 to December 31, 2012 in Guinea, of which 558 (17.5%) performed susceptibility testing to anti-TB drugs. We found overall resistance in 417 cases (74.7%) including 356 (85.4%) of multidrug resistance (MDR), 29 (6.9%) of monoresistance (isoniazid 2.9%, streptomycin 2.9%, rifampicin 0.9%, ethambutol 0.2%) and 32 (7.7% of polydrug resistance (isoniazid + streptomycin 4.3%, rifampicin + streptomycin 1.4%, isoniazid + ethambutol + streptomycin 1.0%, rifampicin + ethambutol + streptomycin 1.0%). Most of the patients (84.6%) with anti-TB drugs resistance were under 45 and labourers were mostly represented (27.8%) including drivers in majority (37.9%). MDR-TB incidence rate increased by 12.2% between 2008 (65.6%) and 2012 (77.8%), and the annual cure rate decreased gradually from 60.0% in 2009 to 45.7% in 2012. Among MDR-TB patients (n= 356), only 112 (31.5%) benefited from second-line treatment regimen, of which, 51.7% were cured, 6.3% completed treatment, 24.1% died, 6.3% were lost to follow-up and 11.6% were not evaluated. The cure rate was higher in HIV-negative patients (55.3%) than in those who were HIV-positive (35.3%) and the death rate was the highest (41.2%) in HIV-positive patients. Overall, treatment success rate was 58.0%. This study revealed a low rate of performing drug susceptibility testing, the gradual increase of the incidence of MDR-TB each year and the gradual decrease of cure rate from year to year. Besides, anti-TB drugs resistance concerned mostly drivers in our context. Prospective studies are needed for a deep understanding of the factors associated with these persistent challenges.
Highlights
Tuberculosis (TB) is a major public health issue, caused by Mycobacterium tuberculosis [1,2]
3187 retreatment TB patients were notified in Guinea between 2008 and 2012, of which 558 cases (17.5%) were tested for susceptibility to first-line anti-TB drugs at the national reference laboratory of mycobacteria
multidrug-resistant TB (MDR-TB) incidence rate increased by 12.2%, from 65.6% in 2008 to 77.8% in 2012
Summary
Tuberculosis (TB) is a major public health issue, caused by Mycobacterium tuberculosis [1,2]. Despite progress in decreasing TB incidence (2% per year) and reducing mortality (about 3% per year) worldwide, 16% of patients. Science Journal of Public Health 2019; 7(5): 167-173 died of this disease in 2017 [2]. TB is one of the top 10 causes of death and the leading cause from a single infectious agent (above HIV/AIDS) worldwide [2,3], while its treatment success is globally low (55%) [2]. In 2014, the highest TB incidence rate was recorded in Asia (61%), followed by Africa (26%) from where came the 74% of all HIV-positive TB patients reported in the world [4]. The fight against TB drug resistance remains a major public health concern worldwide
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