Abstract
BackgroundIsoniazid resistant tuberculosis is the most prevalent type of resistance in Swaziland and over two-thirds of the isoniazid resistant tuberculosis patients are tuberculosis and human immunodeficiency virus co-infected. The study aimed to determine risk factors associated with isoniazid resistant tuberculosis among human immunodeficiency virus positive patients in Swaziland.MethodsThis was a case-control study conducted in nine healthcare facilities across Swaziland. Cases were patients with isoniazid resistant tuberculosis (including 78 patients with isoniazid mono-resistant tuberculosis, 42 with polydrug-resistant tuberculosis, and 77 with multidrug-resistant tuberculosis). Controls were presumed drug-susceptible tuberculosis patients (n = 203). Multinomial logistic regression was used to determine related factors.ResultsThe median time lag from diagnosis to tuberculosis treatment initiation was 50 days for isoniazid mono or poly drug-resistant tuberculosis, 17 days for multidrug-resistant tuberculosis compared to 1 day for drug-susceptible tuberculosis patients. History of previous tuberculosis treatment was positively associated with either isoniazid mono or poly drug-resistant tuberculosis (OR = 7.91, 95% CI: 4.14–15.11) and multidrug-resistant tuberculosis (OR = 12.20, 95% CI: 6.07–24.54). Isoniazid mono or poly resistant tuberculosis patients were more likely to be from rural areas (OR = 2.05, 95% CI: 1.23–3.32) and current heavy alcohol drinkers compared to the drug-susceptible tuberculosis group. Multi drug-resistant tuberculosis patients were more likely to be non-adherent to tuberculosis treatment compared to drug-susceptible tuberculosis group (OR = 3.01, 95% CI: 1.56–5.82).ConclusionTo prevent and control isoniazid resistant tuberculosis among HIV-positive patients in Swaziland, the tuberculosis program should strengthen the use of rapid diagnostic tests, detect resistance early, promptly initiate supervised tuberculosis treatment and decentralize quality tuberculosis services to the rural areas. Adherence to tuberculosis treatment should be improved.
Highlights
Isoniazid resistant tuberculosis is the most prevalent type of resistance in Swaziland and over twothirds of the isoniazid resistant tuberculosis patients are tuberculosis and human immunodeficiency virus coinfected
Most of the cases were unemployed compared to controls, with 50% of HR-TB or PDR-TB patients and 44.2% of multidrug-resistant TB (MDR-TB) patients being unemployed compared to only 35.1% of drug-susceptible TB (DS-TB) patients (p = 0.028)
Higher percentage of the cases lived in rural areas compared to controls with 60.8% of HR-TB or PDR-TB patients and 51.9% of MDR-TB patients living in rural areas compared to 41.1% of DS-TB patients (p = 0.003)
Summary
Isoniazid resistant tuberculosis is the most prevalent type of resistance in Swaziland and over twothirds of the isoniazid resistant tuberculosis patients are tuberculosis and human immunodeficiency virus coinfected. The study aimed to determine risk factors associated with isoniazid resistant tuberculosis among human immunodeficiency virus positive patients in Swaziland. A survey in 2008 revealed that 10.3% of new cases and 27.7% of previously treated cases had TB strains resistant to isoniazid worldwide [1]. In 2015, 3.9% of new cases and 21% of previously treated cases had multidrug-resistant TB (MDR-TB) or rifampicin-resistant TB (RR-TB) [2]. Isoniazid resistant TB is the most prevalent type of resistance in Swaziland, and is a major concern, because isoniazid is one of the most effective and specific first-line drugs for the prevention and treatment of TB [4, 5]. The development of isoniazid resistant TB is usually the first step in the evolution of MDR-TB or even more complicated types of DR-TB [5,6,7]
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