Abstract
Tuberculosis (TB) is the leading infectious cause of death in the world. Multi-drug resistant TB (MDR-TB) is a major public health problem as treatment is long, costly, and associated to poor outcomes. Here, we report epidemiological data on the prevalence of drug-resistant TB in Haiti. This cross-sectional prevalence study was conducted in five health centers across Haiti. Adult, microbiologically confirmed pulmonary TB patients were included. Molecular genotyping (rpoB gene sequencing and spoligotyping) and phenotypic drug susceptibility testing were used to characterize rifampin-resistant MTB isolates detected by Xpert MTB/RIF. Between April 2016 and February 2018, 2,777 patients were diagnosed with pulmonary TB by Xpert MTB/RIF screening and positive MTB cultures. A total of 74 (2.7%) patients were infected by a drug-resistant (DR-TB) M. tuberculosis strain. Overall HIV prevalence was 14.1%. Patients with HIV infection were at a significantly higher risk for infection with DR-TB strains compared to pan-susceptible strains (28.4% vs. 13.7%, adjusted odds ratio 2.6, 95% confidence interval 1.5-4.4, P = 0.001). Among the detected DR-TB strains, T1 (29.3%), LAM9 (13.3%), and H3 (10.7%) were the most frequent clades. In comparison with previous spoligotypes studies with data collected in 2000-2002 and in 2008-2009 on both sensitive and resistant strains of TB in Haiti, we observed a significant increase in the prevalence of the drug-resistant MTB Spoligo-International-Types (SIT) 137 (X2 clade: 8.1% vs. 0.3% in 2000-02 and 0.9% in 2008-09, p<0.001), 5 (T1 clade: 6.8% vs 1.9 in 2000-02 and 1.7% in 2008-09, P = 0.034) and 455 (T1 clade: 5.4% vs 1.6% and 1.1%, P = 0.029). Newly detected spoligotypes (SIT 6, 7, 373, 909 and 1624) were also recorded. This study describes the genotypic and phenotypic characteristics of DR-TB strains circulating in Haiti from April 2016 to February 2018. Newly detected MTB clades harboring multi-drug resistance patterns among the Haitian population as well as the higher risk of MDR-TB infection in HIV-positive people highlights the epidemiological relevance of these surveillance data. The importance of detecting RIF-resistant patients, as proxy for MDR-TB in peripheral sites via molecular techniques, is particularly important to provide adequate patient case management, prevent the transmission of resistant strains in the community and to contribute to the surveillance of resistant strains.
Highlights
Tuberculosis (TB) is a communicable disease caused by Mycobacterium tuberculosis (MTB)
A total of 74 (2.7%) patients were infected by a drug-resistant (DR-TB) M. tuberculosis strain
Patients with HIV infection were at a significantly higher risk for infection with DR-TB strains compared to pan-susceptible strains (28.4% vs. 13.7%, adjusted odds ratio 2.6, 95% confidence interval 1.5–4.4, P = 0.001)
Summary
Tuberculosis (TB) is a communicable disease caused by Mycobacterium tuberculosis (MTB). In 2018, the death toll for TB among HIVnegative people was estimated to be 1.2 million, with an additional 251 000 deaths among HIV-positive people. The estimated global burden for the same year was about 10 million new cases [1]. The Americas accounted only for 3% of the global TB cases in 2018, Haiti is one of the countries with the highest TB incidence in the Western hemisphere. In 2018, the country reported an incidence of 176 cases per 100,000 population, of which approximately 15% were cases of TB/HIV coinfection [2]. In Haiti, the mortality due to TB is estimated to be 9.2 per 100 000 population for HIV-negative patients, and 7.7 per 100 000 population for HIV-positive patients [3]. The overall HIV prevalence is 2% and has remained stable in the past years, with 160,000 people living with HIV in 2018 including about 8,400 to 10,000 adolescents for whom tailored interventions are needed to improve retention in care [4,5]
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