Drug resistant tuberculosis in Africa: Current status, gaps and opportunities.

Nazir Ismail,Yasmin Gardee,Hendrik Koornhof,Philip C Onyebujoh,Shaheed V Omar,Farzana Ismail,Linsay Blows

doi:10.4102/ajlm.v7i2.781

Abstract

BackgroundThe World Health Organization End TB Strategy targets for 2035 are ambitious and drug resistant tuberculosis is an important barrier, particularly in Africa, home to over a billion people.ObjectiveWe sought to review the current status of drug resistant tuberculosis in Africa and highlight key areas requiring improvement.MethodsAvailable data from 2016 World Health Organization global tuberculosis database were extracted and analysed using descriptive statistics.ResultsThe true burden of drug resistant tuberculosis on the continent is poorly described with only 51% of countries having a formal survey completed. In the absence of this data, modelled estimates were used and reported 92 629 drug resistant tuberculosis cases with 42% of these occurring in just two countries: Nigeria and South Africa. Of the cases estimated, the majority of patients (70%) were not notified, representing ‘missed cases’. Mortality among patients with multi-drug resistant tuberculosis was 21%, and was 43% among those with extensively drug resistant tuberculosis. Policies on the adoption of new diagnostic tools was poor and implementation was lacking. A rifampicin result was available for less than 10% of tuberculosis cases in 23 of 47 countries. Second-line drug resistance testing was available in only 60% of countries. The introduction of the short multi-drug resistant tuberculosis regimen was a welcome development, with 40% of countries having implemented it in 2016. Bedaquiline has also been introduced in several countries.ConclusionDrug resistant tuberculosis is largely missed in Africa and this threatens prospects to achieve the 2035 targets. Urgent efforts are required to confirm the true burden of drug resistant tuberculosis in Africa. Adoption of new tools and drugs is essential if the 2035 targets are to be met.

Highlights

Global declines in tuberculosis incidence[1] provide evidence that political commitment together with aggressive plans to curb the disease can make a difference
Bedaquiline is a new and welcome addition to drug resistant tuberculosis management and is reported to be highly effective.[19,20]. It is currently being used in 11 African countries as well as in South Africa where its use is on a large scale (Figure 1)
The data used were taken from the World Health Organization (WHO) global tuberculosis database, which derived data from countries through unverified self-reporting

Summary

Results

The true burden of drug resistant tuberculosis on the continent is poorly described with only 51% of countries having a formal survey completed. In the absence of this data, modelled estimates were used and reported 92 629 drug resistant tuberculosis cases with 42%. Of these occurring in just two countries: Nigeria and South Africa. The majority of patients (70%) were not notified, representing ‘missed cases’. Mortality among patients with multi-drug resistant tuberculosis was 21%, and was 43% among those with extensively drug resistant tuberculosis. A rifampicin result was available for less than 10% of tuberculosis cases in 23 of 47 countries. Second-line drug resistance testing was available in only 60% of countries. The introduction of the short multi-drug resistant tuberculosis regimen was a welcome development, with 40% of countries having implemented it in 2016.

Conclusion

Introduction

Limitations