Ta. Kenyon et al., Low levels of drug resistance amidst rapidly increasing tuberculosis and human immunodeficiency virus co-epidemics in Botswana, INT J TUBE, 3(1), 1999, pp. 4-11
Citations number
53
Categorie Soggetti
Cardiovascular & Respiratory Systems
Journal title
INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE
SETTING: Botswana, southern Africa, where the tuberculosis (TB) case rate i
ncreased by 120% from 1989 to 1996 in spite of a decade of implementation o
f the directly observed therapy, short-course (DOTS) strategy.
OBJECTIVE: To determine prevalence of and risk factors for drug-resistant t
uberculosis in an epidemic setting.
DESIGN: Systematic national random survey of newly diagnosed pulmonary TB a
nd all patients with TB requiring retreatment during 1995-1996. Interviews
were conducted, human immunodeficiency virus (HIV) testing was offered, and
drug susceptibility testing was performed for isoniazid, rifampicin, strep
tomycin and ethambutol.
RESULTS: Resistance to at least one drug was identified in 16 (3.7%) new ca
ses and 18 (14.9%) retreatment cases. One (0.2%) new and seven (5.8%) retre
atment cases had resistance to at least both isoniazid and rifampicin (mult
idrug-resistant TB). Retreatment cases with multidrug-resistant TB were sig
nificantly more likely to have worked in the mines in South Africa than wer
e cases with fully susceptible isolates (6/7 [85.7%] versus 32/103 [31.1%],
odds ratio 13.3, 95% confidence interval 1.5-311.0, P = 0.007). Of 240 pat
ients tested for HIV, 117 (48.8%) were positive; prevalence was similar amo
ng new and retreatment cases, and was not a risk factor for drug resistance
in either group.
CONCLUSION: During the HIV and TB co-epidemics in sub-Saharan Africa, DOTS
may help to control drug-resistant TB. However, the TB case rate can be exp
ected to continue to climb in spite of the implementation of the DOTS strat
egy.