Detection and management of drug-resistant tuberculosis in HIV-infected patients in lower-income countries

Abstract

Setting Drug resistance threatens tuberculosis (TB) control, particularly among HIV-infected persons. Objective We surveyed antiretroviral therapy (ART) programs from lower-income countries on prevention and management of drug-resistant TB. Design We used online questionnaires to collect program-level data in 47 ART programs in Southern Africa (14), East Africa (8), West Africa (7), Central Africa (5), Latin America (7) and Asia-Pacific (6 programs) in 2012. Patient-level data were collected on 1,002 adult TB patients seen at 40 of the participating ART programs. Results Phenotypic drug susceptibility testing was available at 36 (77%) ART programs, but only used for 22% of all TB patients. Molecular drug resistance testing was available at 33 (70%) programs and used for 23% of all TB patients. Twenty ART programs (43%) provided directly observed therapy (DOT) during the whole treatment, 16 (34%) during intensive phase only and 11 (23%) did not follow DOT. Fourteen (30%) ART programs reported no access to second-line TB regimens; 18 (38%) reported TB drug shortages. Conclusions Capacity to diagnose and treat drug-resistant TB was limited across ART programs in lower income countries. DOT was not always implemented and drug supply was regularly interrupted, which may contribute to the global emergence of drug resistance.

Prevalence of Drug Resistance Mycobacterium Tuberculosis among Patients Seen in Coast Provincial General Hospital, Mombasa, Kenya

“…This is partly due to poor laboratory facilities, surveillance mechanisms, as well as reporting procedures [ 21 ]. HIV infection, in particular, is known to be associated with higher risk of TB and increases the lifetime risk of progression from Mycobacterium tuberculosis infection to active disease [ 22 ]. Similarly, Tuberculosis (TB) is one of the most common opportunistic co-infections among HIV-infected individuals, particularly in resource-limited settings, with drug resistance resulting from inappropriate treatment [ 23 ].…”

International epidemiology databases to evaluate AIDS (IeDEA) in sub-Saharan Africa, 2012–2019

“…7 Other studies examined the management of mental health and substance use disorders, 8 or the diagnostic and screening practices for (drug resistant) tuberculosis in adult and paediatric patients. [9][10][11] Furthermore, the routine data collected by participating sites have been enriched in some countries by linking the HIV databases to cancer registries, 12 13 vital registries 14 or administrative databases. 15 Trends in Cd4 cell count and viral load measurements While WHO continues to recommend a CD4 cell count before starting ART to inform the management of advanced disease and differentiated care in the Treat All era, it also recommends that CD4 testing be replaced by viral load measurement for monitoring of treatment and identification of treatment failure.…”

Cohort profile: The International epidemiology Databases to Evaluate AIDS (IeDEA) in sub-Saharan Africa, 2012-2019

“…For example, a study compared the characteristics and comprehensiveness of adult HIV care and treatment programmes in sub-Saharan Africa with programmes in the Americas and Asia-Pacific region [7]. Other studies examined the management of mental health and substance use disorders [8], or the diagnostic and screening practices for (drug resistant) tuberculosis in adult and paediatric patients [9][10][11]. Furthermore, the routine data collected by participating sites have been enriched in some countries by linking the routine HIV databases to cancer registries [12,13], vital registries [14] or administrative databases [15].…”