Number Of Tuberculosis Cases Research Articles

USA's expanded overseas tuberculosis screening program: a retrospective study in China.

BackgroundTo address increasing tuberculosis (TB) incidence in foreign-born populations, immigrant TB screening programs have been implemented in the USA. These programs are modified periodically, the effectiveness of which have been disputed. The aim of this retrospective study was to assess the value of the 2009 Technical Instructions for Tuberculosis Screening and Treatment Using Cultures and Directly Observed Therapy (CDOT TB TI) in a cohort of the USA permanent-resident applicants from China.MethodsStandardized forms were used to collect demographic, clinical, and laboratory data of Chinese individuals screened at the Guangdong International Travel Healthcare Center for permanent residence in the USA between October 08, 2009 and December 31, 2012. Applicants’ data were further retrospectively evaluated by three experienced panel physicians and radiologists according to the 1991 Technical Instructions for Tuberculosis Screening and Treatment (TI). TB cases and characteristics identified by the 1991 and expanded 2009 programs were compared.ResultsThe CDOT TB TI identified more than twice as many TB cases that required treatment completion before clearance for travel than the 1991 TI (270 vs. 131). In addition, the expanded screening program identified more cases of negative sputum smear but positive culture (181 vs. 44), and more cases of radiography suggestive of inactive (22 vs. 3) and active (248 vs. 128) TB. Specifically, the 1991 TI screening program failed to identify 25/38 (65.79%) cases carrying drug-resistant isolates, and 13/131 (9.92%) would have been inappropriately treated. Moreover, 220/270 (81.48%) of the cases were asymptomatic, which were identified by screening and subsequently treated. Improved chest radiograph and sputum negative conversion occurred in all treated cases.ConclusionCDOT TB TI, a screening program that includes sputum culture and drug susceptibility tests, identifies a greater number of TB cases, likely contributing to the overall decrease in TB prevalence in host (USA) and origin (China) countries.

Follow-up of chronic coughers improves tuberculosis case finding: results from a community-based cohort study in southern Ethiopia.

BackgroundUntreated smear-positive tuberculosis (TB) patients are the primary source of infection; however, a large number of TB cases have not been identified and are untreated in many sub-Saharan African countries, including Ethiopia. This study determined whether or not a community-based follow-up of chronic coughers improves detection of TB cases and the risk factors for death among such cases.MethodsWe conducted a census in six rural communities in Sidama, southern Ethiopia. Based on interview and sputum investigation, we identified 724 TB smear-negative chronic coughers, and did a cohort study of these chronic coughers and 1448 neighbourhood controls. For both chronic coughers and neighbourhood controls, we conducted a TB screening interview and performed sputum microscopy, as required, at 4, 7 and 10 months. Between September 2011 and June 2012, we followed chronic coughers and neighbourhood controls for 588 and 1,204 person-years of observation, respectively.ResultsOf the chronic coughers, 23 developed smear-positive TB (incidence rate = 3912/105 person-years) compared to three neighbourhood controls who developed smear-positive TB (incidence rate = 249/105 person-years). The male-to-female ratio of smear-positive TB was 1:1. We demonstrated that chronic coughers (adjusted hazards ratio [aHR], 13.5; 95% CI, 4.0–45.7) and the poor (aHR, 2.6; 95% CI, 1.1–5.8) were at high-risk for smear-positive TB. Among the study cohort, 15 chronic coughers and two neighbourhood controls died (aHR, 14.0; 95% CI, 3.2–62.4).ConclusionA community-based follow-up of chronic coughers is helpful in improving smear-positive TB case detection, it benefits socioeconomically disadvantaged people in particular; in rural settings, chronic coughers had a higher risk of death.

Relevance of imaging in the evaluation of abdominal tuberculosis.

Tuberculosis is an infection highly prevalent worldwide, con-sidered to be a global health problem by the World Health Orga-nization. Currently, it is considered the most important commu-nicable disease in the world whose dissemination reaches acrossthe boundaries of developing countries. The number of tuberculo-sis cases has also been increasing in developed countries, mainlybecause of immigration between nations, as a consequence ofacquired immunodeficiency syndrome (AIDS), and also becauseof the utilization of immunosuppressive drugs. To give an idea aboutthe dissemination of such an infection, it is believed that one-halfof the world’s population has already had contact with the tu-bercle bacillus, and more than 10 million cases are diagnosedevery year

Abdominal Tuberculosis: An Immigrant's Disease in the United States.

Background:Abdominal tuberculosis (TB) is an uncommon condition in the United States (US) except for patients with human immunodeficiency virus (HIV). An increasing number of cases have been reported in western countries amongst immigrants. It is important to be aware of the data and clinical characteristics in the immigrant population.Aims:The purpose of this study is to determine the epidemiologic characteristics of abdominal TB among immigrants in the US and to review the clinical presentations of abdominal TB with a focus particularly on unusual features.Materials and Methods:In a community teaching hospital in New Jersey, patients diagnosed with abdominal TB were examined and included in this report. All nine patients were immigrants from countries with high prevalence of TB and a majority had resided in the US for at least 5 years. None had clinical evidence of HIV and those that were tested were not found to be positive for HIV. Initial examination, diagnostic workup, and response to therapy were all pertinent to the management and diagnosis of these patients.Results:Three patients had atypical clinical presentations with normal chest X-rays and either negative or unknown tuberculin tests leading to delayed diagnosis and inappropriate therapy in at least one patient. With antituberculous therapy, all except for one patient had satisfactory outcomes. Immigrant patients with a diagnosis of abdominal TB had no evidence of HIV infection or other associated conditions in contrast to native-born individuals.Conclusion:Atypical presentations may cause diagnostic difficulties. Failure to perform appropriate tests may lead to inappropriate therapy with adverse outcomes. Although there is a decline in the number of TB cases in the US and screening for latent pulmonary infection in foreigners has been implemented effectively, the diagnosis of abdominal TB continues to be under diagnosed.

Gender patterns of tuberculosis testing and disease in South Africa

In South Africa, tuberculosis (TB) has been the leading cause of death for over a decade. The TB incidence rate is the second highest in the world, and continues to rise. To examine gender patterns in South Africa's TB epidemic. This is one of the first studies to use National Health Laboratory Service (NHLS) data to evaluate the epidemic at the national level. Observational study using NHLS retrospective data for every TB test performed in public health facilities between 2009 and 2011. Despite an increase in the number of TB tests performed, the number of TB cases remained relatively constant. Although prevalence rates differ between health districts, we find a similar female-to-male ratio (0.70) in each district. The age profile for TB resembles that of human immunodeficiency virus (HIV), with peak TB prevalence in women occurring 7 years earlier than in men. The female-to-male ratio of TB cases and 3+ positive (severe) cases decreases rapidly between ages 25 and 35 years. These age and gender patterns are driven by the HIV epidemic and risks associated with pregnancy and childbearing. Increasing the quality and quantity of active TB case finding at existing points of care would be a sustainable and cost-effective intervention for both treatment and prevention.

The association of extreme temperatures and the incidence of tuberculosis in Japan.

Seasonal variation in the incidence of tuberculosis (TB) has been widely assumed. However, few studies have investigated the association between extreme temperatures and the incidence of TB. We collected data on cases of TB and mean temperature in Fukuoka, Japan for 2008-2012 and used time-series analyses to assess the possible relationship of extreme temperatures with TB incident cases, adjusting for seasonal and interannual variation. Our analysis revealed that the occurrence of extreme heat temperature events resulted in a significant increase in the number of TB cases (relative risk (RR) 1.20, 95 % confidence interval (CI) 1.01-1.43). We also found that the occurrence of extreme cold temperature events resulted in a significant increase in the number of TB cases (RR 1.23, 95 % CI 1.05-1.45). Sex and age did not modify the effect of either heat or cold extremes. Our study provides quantitative evidence that the number of TB cases increased significantly with extreme heat and cold temperatures. The results may help public health officials predict extreme temperature-related TB incidence and prepare for the implementation of preventive public health interventions.

Tuberculous Pleural Effusion

Tuberculous pleural effusion (TBPE) is the most common form of extrapulmonary tuberculosis (TB) in Spain, and is one of the most frequent causes of pleural effusion. Although the incidence has steadily declined (4.8 cases/100000 population in 2009), the percentage of TBPE remains steady with respect to the total number of TB cases (14.3%–19.3%). Almost two thirds are men, more than 60% are aged between 15 and 44years, and it is more common in patients with human immunodeficiency virus. The pathogenesis is usually a delayed hypersensitivity reaction. Symptoms vary depending on the population (more acute in young people and more prolonged in the elderly). The effusion is almost invariably a unilateral exudate (according to Light's criteria), more often on the right side, and the tuberculin test is negative in one third of cases.There are limitations in making a definitive diagnosis, so various pleural fluid biomarkers have been used for this. The combination of adenosine deaminase and lymphocyte percentage may be useful in this respect. Treatment is the same as for any TB. The addition of corticosteroids is not advisable, and chest drainage could help to improve symptoms more rapidly in large effusions.

Profile of tuberculosis patients with delayed sputum smear conversion in the Pacific island of Vanuatu.

National tuberculosis control programme, Vanuatu. To assess tuberculosis (TB) trends, characterise sputum smear-positive patients with non-conversion at 2 months and assess their treatment outcomes. Evaluation of programme data over a 9-year period (2004-2012), comparing 2-month sputum non-converters (delayed converters) with sputum smear converters diagnosed in 2011 and 2012. Annual TB case numbers were similar over the study period, with an average TB notification rate of 58 per 100 000 population. Of 417 sputum smear-positive cases, 74 (18%) were delayed converters. Delayed converters were more likely than converters (88% vs. 79%) to have had high pre-treatment sputum smear grades (OR 2.5, 95%CI 0.97-6.45). Among delayed converters, treatment adherence was high (99% good adherence), outcomes were generally good (90% treatment success, 85% cure, 4% treatment failure) and no drug resistance was detected. Deaths were unexpectedly common among converters (11/80, 14%), with significantly more deaths in Tafea than in Shefa Province (7/58 vs. 2/80, OR 5.35, 95%CI 1.07-26.79). Tafea Province also had the greatest number of delayed converters (30/74, 40.5%) and the highest TB incidence rate. Delayed sputum conversion was relatively uncommon, and was not associated with adverse outcomes or drug resistance. Regional differences require further investigation to better understand local factors that may compromise patient management.

Surgical treatment of perforative tubercular intestines ulcers at patients with HIV infection

High incidence of HIV infection leads to increase in number of tuberculosis cases. The Abdominal Tuberculosis (AT) makes 1/4 among other extra pulmonary localizations at patients with late stages of HIV infection. The worst complication of AT is perforation of tubercular ulcers of intestines when the lethality reaches 80%. The clinical material is presented by 76 patients with HIV infection in 4B stage and ruptured tubercular intestines ulcers. Depending on localization of ulcers, resection of small intestine or a right-sided hemicolectomy was made. The first group included 40 patients, the second one - 36. Duration of HIV infection was 7-8 years. The periods from the moment of perforation to operation varied from 12 to 36 hours. In group 1 primary anastomosis was not made, leaving the created stumps of bringing and taking-away departments of intestines in an abdominal cavity, carrying out a decompression of bringing department of intestines. Relaparotomy was carried out with an interval of 48 hours. After knocking peritonitis two-row anastomosis was made. In group 2 resection of a gut was finished with one-stage anastomosis, sanitation of an abdominal cavity was made. Active heavy bilateral processes prevailed among the other forms of lungs tuberculosis. The patients’ number of CD4 was noted to have decreased lower than 150, at this time at the number of CD4 of 55 (72,4%) patients was less than 50. Tuberculosis colitis at all patients was presented by infiltrative and ulcer form. In 25% of all the cases acid resisting mycobacterium was revealed in the exudate received from an abdominal cavity by luminescent microscopy method. During luminescent microscopy of ulcers edges, mycobacterium tuberculosis was always revealed. In group 1 the results of the treatment were better: the faster recover from peritonitis was note, and there was no insolvency anastomosis, perforation of new tubercular intestines ulcers was noted at 8 patients. 14 patients delivered in a sad plight with intense immunodeficiency died of accruing polyorgan insufficiency. In group 2 - 28 patients died, at 18 of which new guts perforation and peritonitis progressing occurred what required repeated surgeries.

Derrame pleural tuberculoso

Tuberculous pleural effusion (TBPE) is the most common form of extrapulmonary tuberculosis (TB) in Spain, and is one of the most frequent causes of pleural effusion. Although the incidence has steadily declined (4.8 cases/100,000population in 2009), the percentage of TBPE remains steady with respect to the total number of TB cases (14.3%-19.3%). Almost two thirds are men, more than 60% are aged between 15-44years, and it is more common in patients with human immunodeficiency virus. The pathogenesis is usually a delayed hypersensitivity reaction. Symptoms vary depending on the population (more acute in young people and more prolonged in the elderly). The effusion is almost invariably a unilateral exudate (according to Light's criteria), more often on the right side, and the tuberculin test is negative in one third of cases.There are limitations in making a definitive diagnosis, so various pleural fluid biomarkers have been used for this. The combination of adenosine deaminase and lymphocyte percentage may be useful in this respect. Treatment is the same as for any TB. The addition of corticosteroids is not advisable, and chest drainage could help to improve symptoms more rapidly in large effusions.

Prevalence of tuberculosis: A study in forensic autopsies

Background: Tuberculosis is a major cause of morbidity and mortality in developing countries. There are many cases of tuberculosis which remain undiagnosed and are diagnosed only at autopsy. Materials and Methods: This retrospective study was conducted on cases brought for forensic autopsy in a tertiary care medical centre from the year 2003 to 2012. The history, post-mortem findings, and histopathological findings of the cases were meticulously studied and analyzed. Results: Out of the total 4,415 autopsies, 74 cases had findings of tuberculosis. Males outnumbered females, and the highest number of tuberculosis cases was observed in males in the age-groups of 40 to 50 years (32.43%) followed 50 years and above (25.67%). Tuberculosis as to be the primary cause of death was observed in 28.38% of the cases, of which 22.97% were pulmonary while 5.41% were cases of disseminated/extrapulmonary tuberculosis. In the lung, active tuberculosis was observed in 34.28%, i.e., granulomatous inflammation with caseation necrosis (27.14%) or granulomatous inflammation with caseation necrosis and tubercular pneumonia (7.14%). Suspicious cases of inactive tuberculosis, i.e., fibrosis and calcification was observed in 65.71% of the cases. Conclusion: The chance finding of tuberculosis in forensic autopsy cases in this study highlights that there are undiagnosed cases of active tuberculosis who are not seeking proper medical attention and these cases may pose as a source of transmission to the general public, health-care providers and mortuary staff.

Prediction of the Number of Tuberculosis Cases and Estimation of Its Treatment Cost in Saudi Arabia Using Proxy Information

It is well known that the number of people with Tuberculosis (TB) and those who develop multidrug resistance (MDR) are the fundamental components that affect the total cost of treatment of TB. This paper has two-fold objectives. Firstly, we use the Generalized Linear Regression Models (GLM) to predict the future count of persons with TB and MDR. Due to the fact that assessment of TB cost is methodologically difficult, and compounded with the lack of concrete information about the treatment cost in Saudi Arabia, our second objective is to use cost information from the EU countries as proxy to estimate the cost of treating TB. The cost predictions provide essential information that is part of the evidence needed for budgeting and financing the health care facilities of TB services, especially with respect to avoiding under-estimation of the cost of TB-MDR treatment.

Tuberculosis Incidence and Case Notification Rates in Kosovo and the Balkans in 2012: Cross-country Comparison.

Aim:Tuberculosis (TB) continues to be a considerable burden especially for millions of young adults and disadvantaged people worldwide. The TB incidence and notification rates are good indicators of TB situation in a country. Our aim was to compare TB incidence and notification rates in Kosovo and in seven other Balkan countries.Methods:Retrospective epidemiologic analysis of published data on TB incidence and notification rates in eight Balkan countries in 2012. Notification rates were expressed per 100,000 inhabitants and were calculated based on the number of TB cases reported divided by the population of each country under analysis.Results:The TB incidence in Kosovo (47/100,000) was considerably higher compared to its four neighboring countries: Albania (16/100,000), Macedonia, Montenegro (18/100,000) and Serbia (23/100,000). The TB notification rates in Kosovo and other countries closely mimicked the incidence rates in these countries.Conclusion:The exceptionally high TB incidence rate in Kosovo could be due to many factors including low health and medical-seeking behaviors of the local population, poverty and low education levels. Effective interventions should be adapted to the local context in order to increase the chances of success.

C-reactive protein and tuberculosis screening: a new trick for an old dog? [Correspondence

In resource-limited settings, the challenge of screening for active tuberculosis (TB) among people living with human immunodeficiency virus infection (PLHIV) is a barrier to the timely initiation of antiretroviral therapy (ART) and the provision of isoniazid preventive therapy (IPT). To streamline screening for TB, the World Health Organization (WHO) recommends a simplified four-part symptom screen.1 However, recent prospective studies have suggested that symptom-based screening would deny most PLHIV immediate access to IPT because the vast majority screen positive despite not having active TB.2,3 We therefore read with great interest the recent article by Lawn and colleagues that examined the diagnostic accuracy and prognostic value of serum C-reactive protein (CRP) as a TB screening tool among PLHIV in South Africa.4 They found that very low ( 400 mg/l) CRP levels were useful respectively for ruling out or ruling in TB. However, because only 14% of patients had very low or very high CRP levels, the authors concluded that CRP was not useful as a TB screening test. We believe that a different conclusion could be reached by comparing CRP with the WHO symptom screen. In their study, using a standard cut-off of 10 mg/l, CRP had similar sensitivity (85% vs. 83%) for active TB to that of the WHO symptom screen, while delivering much higher specificity (58% vs. 33%). Thus, CRP testing would have correctly identified two more TB cases than symptom-based screening, and 101 more patients (239 vs. 138) as immediately eligible for ART and IPT. Lawn and colleagues have previously shown that Xpert® MTB/RIF (Cepheid, Inc, Sunnyvale, CA, USA) and Determine™ TB-LAM (Alere, Inc, Waltham, MA, USA) had lower sensitivity than symptom-based screening in the same study setting,2,5 which leads us to ask: could CRP be the best rapid TB screening tool currently available for PLHIV? While CRP is less sensitive for TB than mycobacterial culture, the most sensitive test available, culture is not feasible in most endemic settings. Clearly, some TB cases will always be missed by any screening strategy that is not 100% sensitive. The cost of missing patients with TB includes possible generation of drug resistance with isoniazid monotherapy, while the benefits to patients without TB include improved outcomes resulting from early ART initiation and possible prevention of future TB with IPT. On a population level, the cost-benefit ratio will depend not only on the accuracy of the screening test but also on the TB prevalence in the population being screened: the cost of screening will be lower with decreasing prevalence (fewer TB cases missed), while the benefits of screening will increase (more patients without TB initiating early ART and IPT). Although novel markers are clearly needed, CRP-based TB screening should be evaluated further, particularly in settings where TB prevalence is considerably lower than in Cape Town. In these settings, CRP-based TB screening could enable considerably more patients to begin IPT immediately relative to the WHO symptom screen, while missing a similar number of TB cases. Studies assessing patient outcomes following CRP-based TB screening could help quantify the relative cost of missed TB cases vs. the benefits expected from rapid initiation of ART and IPT.

Die soziale Dimension der Tuberkulose in der Stadt München

Germany is a low-incidence country for tuberculosis, but there is no time for complacency. With an annual incidence of 10 per 100,000 population the City of Munich counts twice as many cases of tuberculosis compared to the national average. Reasons for the concentration of tuberculosis in big cities include the high proportion of migrants from countries with high prevalence of tuberculosis and from socioeconomically disadvantaged populations. Munich's population is growing fast and is expected to exceed 1.5 million in the near future. Migrants looking for employment now come predominantly from Romania, Bulgaria and Poland. The proportion of foreign born patients with tuberculosis increased over the last ten years from 49 to 80 %. Asylum seekers and migrants need special attention from the public tuberculosis services. The proportion of tuberculosis patients with social problems increased from 37 to 55 % over the last 6 years. Demands for medical and social support have increased and the case management is increasingly complex. In 2011 the ambulatory treatment of 6 immigrants was supervised by the public health services in Munich. Increasingly, uninsured patients from southeastern states of the European Union need medical treatment. In Europe the overall number of tuberculosis cases is decreasing. The proportion of multidrug-resistant (MDR) tuberculosis in Eastern Europe is alarming. 15 of worldwide 27 countries with the highest MDR load are located in the European Region. In Munich the number of MDR cases is still low at 1-4 cases each year. But duration, cost and side effects of therapy are strong barriers to treatment success. All patients have the right to get adequate diagnostic work-up and effective treatment no matter in which country they reside. To realize this request with cross-border control and care, is a big challenge to the public health service in a global perspective.

P99 Impact of TB cluster investigation in a new migrant community

In a high incidence area of tuberculosis (TB), clinicians and nurses identified a sharp increase in the number of TB cases originating from a single country in March 2012 (average...

P222 Pleural TB: a common cause of pleural effusion in South London

BackgroundPleural tuberculosis (TB) is one of the most common forms of extrapulmonary TB, reported to account for up to 25% of TB infected adults, and 30% of exudative pleural effusions...

High prevalence of tuberculosis diagnosed during autopsy examination at Muhimbili National Hospital in Dar es Salaam, Tanzania.

The primary aims of tuberculosis (TB) control programmes is early diagnosis and prompt treatment of infectious cases to limit transmission. Failure to diagnose and adequately treat TB could lead to premature death and unrecognized transmission of Mycobacterium tuberculosis. The proportion of missed TB cases has not been reported in Tanzania. The objective of this study was to quantify the number of cases of TB identified by autopsy. Deceased morbid bodies from Muhimbili National Hospital were involved. Retrieval of admission, diagnostic and other important records used to manage the patient after admission was done. Demographic information, site and type of disease, past medical history, chest x-ray report, clinical diagnosis and cause of death reported upon death certification were recorded. Lung tissues, lymphnodes and blood clots for HIV testing were collected. Biopsy tissues were processed through Ziehl Nielsen staining and examined by microscopy. The study involved 74 deceased individuals where 56 (75.7%) were males. Information for duration of seeking health care before death was available for 41 (55.4%) subjects. Thirty-four (45.9%) cases received diagnosis before death. The main diagnoses were pneumonia 10 (13.5%), heart failure 6 (8.1%), AIDS-related illnesses 6 (6.8%) and malaria 5 (6.8%). The main clinical findings were wasting (51/74 (68.9%)) and abnormal fluid collection in different body cavities, 61 (50.8%). In 24 out of 71 (33.8%) biopsies acid fast bacilli (AFB) were detected. Records of lymphnodes examination were available in 63 cases and 22 of them had AFB. Twenty-two (34.9%) from the paratracheal and hilar lymphnodes were observed to have AFB. HIV was detected by ELISA in 19 (33.3%) out of 57 deceased, and 12 (63.2%) of the HIV positive deceased were co-infected with TB. Out of the 22 cases positive for AFB on tissue-biopsies 12 (54.5%) were HIV positive. There is a high number of TB cases diagnosed after death that could not be detected before they died. There is a need for increased awareness and to include post-mortem data in the annual statistics of TB for precise reporting of the magnitude of the TB burden in the country.

Tuberculosis transmission between foreign- and native-born populations in the EU/EEA: a systematic review

Tuberculosis (TB) control programmes of many low TB incidence countries of the European Union/European Economic Area (EU/EEA) perceive challenges in controlling TB due to high numbers of TB in migrants from high-incidence countries.To assess the extent of TB transmission from the foreign-born to the native-born population, we quantitatively investigated the dynamics of TB transmission between these populations in the EU/EEA, using published molecular epidemiological studies. We searched PubMed and EMBASE databases from 1990 to August 2012.We identified 15 studies performed during 1992–2007 covering 12,366 cases, of which median (range) 49.2% (17.7%–86.4%) were foreign-born. The proportion of clustered isolates ranged between 8.5% and 49.1% of the total number of TB cases genotyped and among these, foreign-born cases were equally or more likely to have unique isolates compared to native-born cases. One third of the clusters were “mixed”, i.e. composed of foreign- and native-born cases, involving 0–34.2% of all genotyped cases. Cross-transmission among foreign and native populations was bidirectional, with wide differences across studies.This systematic review provides evidence that TB in a foreign-born population does not have a significant influence on TB in the native population in EU/EEA.

Eleven-year experience on anti-TB drugs direct susceptibility testing from Siriraj Hospital, Thailand

The early detection of drug-resistant tuberculosis (TB) strains is of utmost importance for patient management and effective TB control programs. This study aimed to demonstrate the performance of direct drug susceptibility testing (DST) performed in our laboratory in the past 11 years. The direct DST was performed on Middlebrook 7H10 medium using isoniazid (INH) and rifampicin (RIF), and the results were compared with those obtained from indirect DST (gold standard). The direct DST was performed with 15,598 smear-positive sputum samples, of which 11,284 (72%) yielded reportable results. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated and revealed 89%, 99%, 95%, and 99%, respectively, for RIF and 90%, 98%, 93%, and 97%, respectively, for INH. Direct DST results could be reported within 1 month after sample processing. This method was also shown to be suitable for use in resource-limited countries, particularly in settings with high numbers of TB cases.