Prevalence of drug-resistant tuberculosis and imputed burden in South Africa: a national and sub-national cross-sectional survey

Ismail, Nazir; Mvusi, Lindiwe; Nanoo, Ananta; Dreyer, Andries; Omar, Shaheed V.; Babatunde, Sanni; Molebatsi, Thabo; Walt, Martie van der; Adelekan, Adeboye; Deyde, Varough; Ihekweazu, Chikwe; Madhi, Shabir A.

doi:10.1016/s1473-3099(18)30222-6

Cited by 67 publications

(63 citation statements)

References 17 publications

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“…This implies that the vast majority of patients with RR-TB were treated without the knowledge of other potential resistances, which could explain the high death rate. The high proportion of rifampicin mono-resistance is similar to what has been reported in South Africa 14,15 and has been linked to acquisition through malabsorption associated with HIV co-infection [16][17][18] . However, we cannot exclude the possibility of ongoing transmission, as approximately 50% of patients diagnosed with RR-TB were new cases.…”

Section: Discussionsupporting

confidence: 71%

Rifampicin Resistant Tuberculosis in Lesotho: Diagnosis, Treatment Initiation and Outcomes

Katende

Esterhuizen

Dippenaar

et al. 2020

Sci Rep

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the Lesotho guidelines for the management of drug-resistant tuberculosis (tB) recommend initiation of patients diagnosed with rifampicin resistant (RR)-tB on a standardized drug resistant regimen while awaiting confirmation of rifampicin resistant TB (RR-TB) and complete drug susceptibility test results. Review of diagnostic records between 2014 and 2016 identified 518 patients with RR-TB. Only 314 (60.6%) patients could be linked to treatment records at the Lesotho MDR hospital. The median delay in treatment initiation from the availability of Xpert MTB/RIF assay result was 12 days (IQR 7-19). Only 32% (101) of patients had a documented first-line drug resistant test. MDR-TB was detected in 56.4% of patients while 33.7% of patients had rifampicin mono-resistance. Only 7.4% of patients assessed for second-line resistance had a positive result (resistance to fluoroquinolone). Treatment success was 69.8%, death rate was 28.8%, loss to follow up was 1.0%, and 0.4% failed treatment. Death was associated with positive or unavailable sputum smear at the end of first month of treatment (Fisher exact p < 0.001) and older age (p = 0.007). Urgent attention needs to be given to link patients with RR-tB to care worldwide. the association of death rate with positive sputum smear at the end of the first month of treatment should trigger early individualization of treatment.

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Section: Discussionsupporting

confidence: 71%

Rifampicin Resistant Tuberculosis in Lesotho: Diagnosis, Treatment Initiation and Outcomes

Katende

Esterhuizen

Dippenaar

et al. 2020

Sci Rep

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“…Details of these surveys are provided elsewhere [11]. The 6 countries represented a range of programmatic and epidemiological settings and included Azerbaijan [12], Bangladesh [13], Belarus (city of Minsk) [14], Pakistan [15], the Philippines [16], and South Africa (Gauteng and Kwazulu Natal provinces) [17]. Data on molecular markers of isoniazid resistance were also available from these countries, as well as for Ukraine [18].…”

Section: Study Populationmentioning

confidence: 99%

Prevalence and genetic profiles of isoniazid resistance in tuberculosis patients: A multicountry analysis of cross-sectional data

et al. 2020

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BackgroundThe surveillance of drug resistance among tuberculosis (TB) patients is central to combatting the global TB epidemic and preventing the spread of antimicrobial resistance. Isoniazid and rifampicin are two of the most powerful first-line anti-TB medicines, and resistance to either of them increases the risk of treatment failure, relapse, or acquisition of resistance to other drugs. The global prevalence of rifampicin resistance is well documented, occurring in 3.4% (95% CI 2.5%-4.4%) of new TB patients and 18% (95% CI 7.6%-31%) of previously treated TB patients in 2018, whereas the prevalence of isoniazid resistance at global and regional levels is less understood. In 2018, the World Health Organization (WHO) recommended a modified 6-month treatment regimen for people with isoniazid-resistant, rifampicin-susceptible TB (Hr-TB), which includes rifampicin, pyrazinamide, ethambutol, and levofloxacin. We estimated the global prevalence of Hr-TB among TB patients and investigated associated phenotypic and genotypic drug resistance patterns. Methods and findingsAggregated drug resistance data reported to WHO from either routine continuous surveillance or nationally representative periodic surveys of TB patients for the period 2003-2017 were reviewed. Isoniazid data were available from 156 countries or territories for 211,753 patients. Among these, the global prevalence of Hr-TB was 7.4% (95% CI 6.5%-8.4%) among new TB patients and 11.4% (95% CI 9.4%-13.4%) among previously treated TB patients. Additional data on pyrazinamide and levofloxacin resistance were available from 6 PLOS Medicine | https://doi.

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“…With an estimated 30.9% case fatality rate [ 20 ], MDR-TB is, in some cases, virtually untreatable and deadly, which further exacerbates the downward cycle of TB-stigma and poor treatment adherence. In KZN, the prevalence of MDR-TB was 2.9% during 2012–2014 [ 21 ], and continues to be a major public health challenge.…”

Section: Introductionmentioning

confidence: 99%

Major depression and household food insecurity among individuals with multidrug-resistant tuberculosis (MDR-TB) in South Africa

Tomita

Ramlall

Naidu

et al. 2019

Soc Psychiatry Psychiatr Epidemiol

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Purpose Household food insecurity in South Africa is a pervasive public health challenge. Although its link to chronic health conditions is well established, its relationship to mental illness, particularly major depression, is not well-understood. Despite KwaZulu-Natal Province being the epicenter of the drug-resistant tuberculosis (MDR-TB) epidemic, and having the largest share of poverty in South Africa, this relationship remains unexamined. This study investigated the association between major depressive episode (MDE) and household food insecurity among individuals with MDR-TB. Methods We enrolled and interviewed 141 newly admitted microbiologically confirmed MDR-TB inpatients at a specialized TB hospital in KwaZulu-Natal Province, South Africa. Logistic regression models were fitted to assess the relationship between MDE and household food insecurity, while accounting for socio-demographic status (e.g., age, gender, education, marital status, social grant status, income, and preference for living in one’s community). Results The prevalence of MDE and household food insecurity was 11.35% and 21.01%, respectively. MDE was significantly associated with household food insecurity (aOR 4.63, 95% CI 1.17–18.38). Individuals who are female (aOR 6.29, 95% CI 1.13–35.03), young (aOR 8.86, 95% CI 1.69–46.34), have low educational attainment (aOR 6.19, 95% CI 1.70–22.59) and receive social grants (aOR 7.60, 95% CI 2.36–24.48) were most at risk of household food insecurity. Conclusions MDE in individuals with MDR-TB was significantly associated with household food insecurity, independent of socio-economic status. Although MDR-TB is not exclusively a disease of the poor, individuals from socio-economically disadvantaged backgrounds (e.g., female, young adults, low education, and social grant recipients) were more likely to experience household food insecurity. Our study underscores the need to address the co-occurring cycles of food insecurity and untreated MDE in South Africa.

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Prevalence of drug-resistant tuberculosis and imputed burden in South Africa: a national and sub-national cross-sectional survey

Abstract: President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention under the terms of 1U19GH000571.

Cited by 67 publications

References 17 publications

Rifampicin Resistant Tuberculosis in Lesotho: Diagnosis, Treatment Initiation and Outcomes

Rifampicin Resistant Tuberculosis in Lesotho: Diagnosis, Treatment Initiation and Outcomes

Prevalence and genetic profiles of isoniazid resistance in tuberculosis patients: A multicountry analysis of cross-sectional data

Major depression and household food insecurity among individuals with multidrug-resistant tuberculosis (MDR-TB) in South Africa

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