The fourth national anti-tuberculosis drug resistance survey in Peru

Quispe, Neyda; Asencios, Luis; Obregón, Cristian; Velásquez, Gustavo E.; Mitnick, Carole D.; Lindeborg, Michael M.; Jave, Hector O.; Solari, Lely

doi:10.5588/ijtld.19.0186

Cited by 18 publications

(14 citation statements)

References 16 publications

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“…Peru is a middle-income country with an estimated TB incidence of 119 per 100,000 and low HIV prevalence in the general population [ 9 ]. In the 2015 national drug resistance survey, 7.3% of patients with TB and no prior treatment history had multidrug-resistant TB [ 16 ]. TB treatment and contact management takes place in primary-level health facilities staffed by generalist doctors.…”

Section: Methodsmentioning

confidence: 99%

Closing delivery gaps in the treatment of tuberculosis infection: Lessons from implementation research in Peru

et al. 2021

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Background Targeted testing and treatment of TB infection to prevent disease is a pillar of TB elimination. Despite recent global commitments to greatly expand access to preventive treatment for TB infection, there remains a lack of research on how best to expand preventive treatment programs in settings with high TB burdens. Methods We conducted implementation research in Lima, Peru, around a multifaceted intervention to deliver TB preventive treatment to close contacts of all ages, health care workers, and people in congregate settings. Key interventions included use of the interferon gamma release assay (IGRA), specialist support for generalist physicians at primary-level health facilities, and treatment support by community health workers. We applied a convergent mixed methods approach to evaluate feasibility and acceptability based on a care cascade framework. Findings During April 2019-January 2020, we enrolled 1,002 household contacts, 148 non-household contacts, 107 residents and staff of congregate settings, and 357 health care workers. Cumulative completion of the TB preventive care cascade was 34% for contacts <5 years old, 28% for contacts 5–19 years old, 18% for contacts ≥20 years old, 0% for people in congregate settings, and 4% of health care workers. IGRA testing was acceptable to adults exposed to TB. Preventive treatment was acceptable to contacts, but less acceptable to physicians, who frequently had doubts about prescribing preventive treatment for adults. Community-based treatment support was both acceptable and feasible, and periodic home-visits or calls were identified as facilitators of adherence. Conclusions We attempted to close the gap in TB preventive treatment in Peru by expanding preventive services to adult contacts and other risk groups. While suboptimal, care cascade completion for adult contacts was consistent with what has been observed in high-income settings. The major losses in the care cascade occurred in completing evaluations and having doctors prescribe preventive treatment.

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Section: Methodsmentioning

confidence: 99%

Closing delivery gaps in the treatment of tuberculosis infection: Lessons from implementation research in Peru

et al. 2021

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“…Peru’s TB incidence is reported to be 119 per 100,000 in the setting of low HIV prevalence, registering 31,764 new cases in 2019 ( World Health Organization, 2020 ). National survey data indicate that 7.3% of patients with TB and no prior treatment were infected with multidrug- resistant strains of the mycobacterium ( Quispe et al, 2020 ). After the declaration of a national emergency over COVID-19, the Peruvian Ministry of Health (MoH) focused efforts on responding to COVID-19 while limiting other health services.…”

Section: Case Studiesmentioning

confidence: 99%

The need for protecting and enhancing TB health policies and services for forcibly displaced and migrant populations during the ongoing COVID-19 pandemic

Knipper¹,

Sedas²,

Keshavjee³

et al. 2021

International Journal of Infectious Diseases

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Disruption of health services due to the COVID-19 pandemic threatens to derail progress being made in tuberculosis control efforts. Forcibly displaced people and migrant populations face particular vulnerabilities as a result of the COVID-19 pandemic, which leaves them at further risk of developing TB. They inhabit environments where measures such as "physical distancing" are impossible to realize and where facilities like camps and informal temporary settlements can easily become sites of rapid disease transmission. In this viewpoint we utilize three case studies-from Peru, South Africa, and Syria-to illustrate the lived experience of forced migration and mobile populations, and the impact of COVID-19 on TB among these populations. We discuss the dual pandemics of TB and COVID-19 in the context of migration through a syndemic lens, to systematically address the upstream social, economic, structural and political factors that -in often deleterious dynamics -foster increased vulnerabilities and risk. Addressing TB, COVID-19 and migration from a syndemic perspective, not only draws systematic attention to comorbidity and the relevance of social and structural context, but also helps to find solutions: the true reality of syndemic interactions can only be fully understood by considering a particular population and bio-social context, and ensuring that they receive the comprehensive care that they need. It also provides avenues for strengthening and expanding the existing infrastructure for TB care to tackle both COVID-19 and TB in migrants and refugees in an integrated and synergistic manner.

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“…When considered globally, individual first line drug resistance values were higher than has been reported in parts of Africa (Ismail et al 2018;Gehre et al 2016;Chonde et al 2010), East Asia (He et al 2008;Bai et al 2007), and South Asia (Tahseen et al 2016), but lower than a South American cohort (Quispe et al 2020). The second line drug resistance rates we observe are higher than reported in the small number of studies which survey second line resistance in new TB cases (Quispe et al 2020;Bai et al 2007;Zhao et al 2012).…”

Section: High Prevalence Of Phenotypic Drug Resistance In Mtb Isolate...mentioning

confidence: 77%

Rapid Acquisition and Transmission of Drug Resistance Amongst Beijing LineageMycobacterium tuberculosisin Vietnam

Silcocks

Chang

Thuong

et al. 2022

Preprint

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Whole genome sequencing (WGS) and phenotypic drug susceptibility testing was performed on a collection of 2,542 Mycobacterium tuberculosis (Mtb) isolates from tuberculosis (TB) patients recruited in Ho Chi Minh City (HCMC), Vietnam, to investigate Mtb diversity, the prevalence and phylodynamics of drug resistance, and in silico resistance prediction with sequencing data. Amongst isolates tested phenotypically against first-line drugs, we observed high rates of streptomycin [STR, 37.7% (N=573/1,520)] and isoniazid resistance [INH, 25.7% (N=459/1,786)], and lower rates of resistance to rifampicin [RIF, 4.9% (N=87/1,786)] and ethambutol [EMB, 4.2% (N=75/1,785)]. Resistance to STR and INH was predicted moderately well when applying the TB-Profiler algorithm to WGS data (sensitivities of 0.81 and 0.87 respectively), while resistance to RIF and EMB was predicted relatively poorly (sensitivities of 0.70 and 0.44 respectively). Rates of multidrug-resistance [(MDR, 3.9% (N=69/1,786)], and resistance to a number of second-line drugs [Para-aminosalicylic acid (29.6% N=79/267), Amikacin (15.4% N=41/267) and Moxifloxacin (21.3%), N=57/267], were found to be high within a global context. Comparing rates of drug resistance among lineages, and exploring the dynamics of resistance acquisition through time, suggest the Beijing lineage (lineage 2.2) acquires de novo resistance mutations at higher rates and suffers no apparent fitness cost acting to impede the transmission of resistance. We infer resistance to INH and STR to have arisen earlier, on average, than resistance to RIF, and to be more widespread across the phylogeny. The high prevalence of background INH resistance, combined with high rates of RIF mono-resistance (20.7%, N=18/87) suggests that rapid assays for INH resistance will be valuable in this setting. These tests will allow the detection of INH mono-resistance, and will allow MDR isolates to be distinguished from isolates with RIF mono-resistance.

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The fourth national anti-tuberculosis drug resistance survey in Peru

Cited by 18 publications

References 16 publications

Closing delivery gaps in the treatment of tuberculosis infection: Lessons from implementation research in Peru

Closing delivery gaps in the treatment of tuberculosis infection: Lessons from implementation research in Peru

The need for protecting and enhancing TB health policies and services for forcibly displaced and migrant populations during the ongoing COVID-19 pandemic

Rapid Acquisition and Transmission of Drug Resistance Amongst Beijing LineageMycobacterium tuberculosisin Vietnam

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