Antituberculosis Drug Resistance Survey in Lesotho, 2008-2009: Lessons Learned

Abstract

SettingDrug resistance is an increasing threat to tuberculosis (TB) control worldwide. The World Health Organization advises monitoring for drug resistance, with either ongoing surveillance or periodic surveys.MethodsThe antituberculosis drug resistance survey was conducted in Lesotho in 2008-2009. Basic demographic and TB history information was collected from individuals with positive sputum smear results at 17 diagnostic facilities. Additional sputum sample was sent to the national TB reference laboratory for culture and drug susceptibility testing.ResultsAmong 3441 eligible smear-positive persons, 1121 (32.6%) were not requested to submit sputum for culture. Among 2320 persons submitted sputum, 1164 (50.2%) were not asked for clinical information or did not have valid sputum samples for testing. In addition, 445/2320 (19.2%) were excluded from analysis because of other laboratory or data management reasons. Among 984/3441 (28.6%) persons who had data available for analysis, MDR-TB was present in 24/773 (3.1%) of new and 25/195 (12.8%) of retreatment TB cases. Logistical, operational and data management challenges affected survey results.ConclusionMDR-TB is prevalent in Lesotho, but limitations reduced the reliability of our findings. Multiple lessons learned during this survey can be applied to improve the next drug resistance survey in Lesotho and other resource constrained countries may learn how to avoid these bottlenecks.

Second nationwide anti-tuberculosis drug resistance survey in Namibia

“…Compared with other countries, the prevalence of MDR-TB in Namibia, as measured among new patients in this survey, is higher than that in South Africa, 10 Malawi, 11 Zambia, 12 and Botswana; 13 comparable with that in Mozambique, 14 Lesotho, 15 and the global average; 1 and lower than that in Swaziland. 16 Similarly, the prevalence of MDRTB observed in previously treated patients in Namibia is higher than that in South Africa, Malawi, Zambia and Botswana; comparable with that in Zambia and Lesotho; but lower than that in Mozambique and Swaziland, as well as the global average (Table 3).…”

Prevalence of drug-resistant tuberculosis in Zimbabwe: A health facility-based cross-sectional survey

“…The observed prevalence of MDR-TB was consistent with prevalence reported from South Africa [(2.1% (95% CI, 1.5, 2.7) and 4.6% (CI, 95%: 3.2, 6.0) among new and previously treated patients, respectively in the 2012-2014 survey] and Botswana [(2.5%, 95% CI, 1.6, 3.7) and 6.6%, 95% CI, 3.3, 11.7) among new and previously treated patients during [2007][2008]] (National Institute for Communicable Diseases 2014; Menzies et al 2014), but was lower than prevalence recorded in both Lesotho [(3.1% (95% CI,2.1,4.3) and (12.8% (95% CI,8.8,18.2)] among previously treated patients and Namibia [(3.8% (95% CI,2.8,5.1) and (16.4% (95% CI, 12.9, 20.6)] among previously treated patients for the survey carried out in 2008-2009(Maama-Maime et al 2015Ministry of Health and Social Services: National Tuberculosis and Leprosy Programme 2012). The increase in the prevalence of RR-TB could be attributed to a high proportion of RMR observed in this study.…”

The fourth national anti-tuberculosis drug resistance survey in Peru

“…Achieving adequate control of drug-resistant tuberculosis requires correct estimates of the disease burden, which allows adequate programming and purchase of the drugs required and appropriate projection of the resources needed for control interventions. 9 Correct estimates can also signal possible gaps in the diagnosis of drug resistance at a programmatic level, in case the estimates based on surveillance systems differ from the ones based on research studies or surveys. This can occur when certain geographical areas have lower DST coverage compared to others.…”