Abstract
In Africa, although emergence of multidrug-resistant (MDR) tuberculosis (TB) represents a serious threat in countries severely affected by the HIV epidemic, most countries lack drug-resistant TB data. This finding was particularly true in the Kingdom of Swaziland, which has the world's highest HIV and TB prevalences. Therefore, we conducted a national survey in 2009-2010 to measure prevalence of drug-resistant TB. Of 988 patients screened, 420 new case-patients and 420 previously treated case-patients met the study criteria. Among culture-positive patients, 15.3% new case-patients and 49.5% previously treated case-patients harbored drug-resistant strains. MDR TB prevalence was 7.7% and 33.8% among new case-patients and previously treated case-patients, respectively. HIV infection and past TB treatment were independently associated with MDR TB. The findings assert the need for wide-scale intervention in resource-limited contexts such as Swaziland, where diagnostic and treatment facilities and health personnel are lacking.
Highlights
Design and Study Population A cross-sectional survey was designed based on the most recent World Health Organization (WHO) guidelines for surveillance of drug resistance in TB [4]
PTCs included patients who returned after defaulting treatment, experienced TB relapses, or had TB treatment failure according to WHO case definitions [10]
new case-patients (NCs) and PTCs, respectively, had MDR. This represents an 8.5-fold and 3.7-fold increase compared with MDR prevalence among NCs and PTCs, respectively, from the previous drug susceptibility testing (DST) survey in 1995
Summary
In Africa, emergence of multidrug-resistant (MDR) tuberculosis (TB) represents a serious threat in countries severely affected by the HIV epidemic, most countries lack drug-resistant TB data. This finding was true in the Kingdom of Swaziland, which has the world’s highest HIV and TB prevalences. MDR TB prevalence was 7.7% and 33.8% among new casepatients and previously treated case-patients, respectively. The HIV epidemic and the emergence of anti-TB drug resistance represent serious threats for achieving the Stop TB Partnership’s goal of eliminating TB as a public health problem by 2050 [2]. In the last WHO report on resistance to anti-TB drugs, data from periodic surveys with relatively recent data were available for only 21 of 46 African countries [5]
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