Abstract
Multidrug-resistant tuberculosis (MDRTB) rates in a human immunodeficiency virus (HIV) care facility increased by the year 2000—56% of TB cases, eight times the national MDRTB rate. We reported the effect of tuberculosis infection control measures that were introduced in 2001 and that consisted of 1) building a respiratory isolation ward with mechanical ventilation, 2) triage segregation of patients, 3) relocation of waiting room to outdoors, 4) rapid sputum smear microscopy, and 5) culture/drug–susceptibility testing with the microscopic-observation drug-susceptibility assay. Records pertaining to patients attending the study site between 1997 and 2004 were reviewed. Six hundred and fifty five HIV/TB–coinfected patients (mean age 33 years, 79% male) who attended the service during the study period were included. After the intervention, MDRTB rates declined to 20% of TB cases by the year 2004 (P = 0.01). Extremely limited access to antiretroviral therapy and specific MDRTB therapy did not change during this period, and concurrently, national MDRTB prevalence increased, implying that the infection control measures caused the fall in MDRTB rates. The infection control measures were estimated to have cost US$91,031 while preventing 97 MDRTB cases, potentially saving US$1,430,026. Thus, this intervention significantly reduced MDRTB within an HIV care facility in this resource-constrained setting and should be cost-effective.
Highlights
IntroductionThe superposition of the human immunodeficiency virus (HIV) and TB epidemics has led to high TB rates and TB outbreaks within HIV care facilities in cities including Madrid, Miami, and New York.[5,6,7,8] In resourceconstrained and wealthier countries alike, most of these outbreaks have involved multidrug-resistant tuberculosis (MDRTB).[6,9,10,11,12] In Latin America, high TB and MDRTB rates in association with HIV coinfection have been reported in Argentina[11,13] and Peru
This study shows that infection control measures designed to prevent TB transmission had a significant impact controlling an outbreak of multidrug-resistant tuberculosis (MDRTB) among human immunodeficiency virus (HIV)-positive patients in a tertiary referral hospital in Lima, Peru
MINSA data corresponding to Lima unless otherwise stated Provision of DST First-line DST provided by National Institutes of Health (NIH) (Peru) for selected patients whose first-line therapy failed Second-line DST provided by Partners in Health (PIH) Second-line DST provided by NIH (Peru) for selected patients whose first-line therapy failed Treatment Provision “DOTS Plus” provided by PIH Standard second-line drugs provided by MINSA Individualized MDR drugs provided by PIH/MINSA Individualized and standardized MDR drugs provided by Global Fund, continued through MINSA No of patients registered with MINSA Total no. of patients treated for MDRTB via MINSA HIV-positive patients receiving second-line TB treatment No of registered XDRTB cases
Summary
The superposition of the HIV and TB epidemics has led to high TB rates and TB outbreaks within HIV care facilities in cities including Madrid, Miami, and New York.[5,6,7,8] In resourceconstrained and wealthier countries alike, most of these outbreaks have involved MDRTB.[6,9,10,11,12] In Latin America, high TB and MDRTB rates in association with HIV coinfection have been reported in Argentina[11,13] and Peru. In Peru, a survey of patients receiving care at 10 large hospitals across Lima and Callao reported that 43% of patients with HIV/TB coinfection had MDRTB, compared with 3.9% of TB patients who were HIV negative.[14]
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