Abstract
BackgroundEmergence of drug resistant tuberculosis (DR-TB) has aggravated the tuberculosis (TB) public health burden worldwide and especially in low income settings. We present findings from a predominantly nomadic population in Karamoja, Uganda with a high-TB burden (3500 new cases annually) and sought to determine the prevalence, patterns, factors associated with DR-TB.MethodsWe used mixed methods of data collection. We enrolled 6890 participants who were treated for tuberculosis in a programmatic setting between January 2015 and April 2018. A cross sectional study and a matched case control study with conditional logistic regression and robust standard errors respectively were used to the determine prevalence and factors associated with DR-TB. The qualitative methods included focus group discussions, in-depth interviews and key informant interviews.ResultsThe overall prevalence of DR-TB was 41/6890 (0.6%) with 4/64,197 (0.1%) among the new and 37/2693 (1.4%) among the previously treated TB patients respectively. The drug resistance patterns observed in the region were mainly rifampicin mono resistant (68.3%) and Multi Drug-Resistant Tuberculosis (31.7%). Factors independently associated with DR-TB were previous TB treatment, adjusted odds ratio (aOR) 13.070 (95%CI 1.552–110.135) and drug stock-outs aOR 0.027 (95%CI 0.002–0.364). The nomadic lifestyle, substance use, congested homesteads and poor health worker attitudes were a great challenge to effective treatment of TB.ConclusionDespite having the highest national TB incidence, Karamoja still has a low DR-TB prevalence. Previous TB treatment and drug stock outs were associated with DR-TB. Regular supply of anti TB medications and health education may help to stem the burden of TB disease in this nomadic population.
Highlights
Emergence of drug resistant tuberculosis (DR-TB) has aggravated the tuberculosis (TB) public health burden worldwide and especially in low income settings
The latest treatment outcome data shows over half of the Multidrug-resistant/ Rifampicin Resistant tuberculosis (MDR/RR-TB) patients who start treatment are successful, mortality rate is at 18%, and those that fail on treatment are 8%
Patients diagnosed with rifampicin resistant TB on the Xpert® MTB/RIF assay are subjected to additional investigations including sputum culture, drug susceptibility testing, chest X-rays, Human Immuno-Deficiency Virus (HIV) tests, thyroid function tests and blood chemistry tests
Summary
Emergence of drug resistant tuberculosis (DR-TB) has aggravated the tuberculosis (TB) public health burden worldwide and especially in low income settings. Treatment of MDR-TB is more than seven times the treatment of susceptible TB and this may deter effectiveness of TB control programs [4, 5] This is because MDR-TB involves expensive second-line regimens given the prolonged treatment [6]. The World Health Organization (WHO) anti-TB drug resistance surveillance data shows that there’s an increasing number of new and previously treated TB cases in the world that have rifampicin or multidrug-resistant tuberculosis [8]. The latest treatment outcome data shows over half of the Multidrug-resistant/ Rifampicin Resistant tuberculosis (MDR/RR-TB) patients who start treatment are successful, mortality rate is at 18%, and those that fail on treatment are 8%. In 2017, WHO reported about 558,000 new cases of MDR/RR-TB and a Case fatality rate of 40% globally and 8.5% of these cases had extensively drug-resistant TB (XDR-TB). This indicates TB is fatal and prevention efforts should be emphasized
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