Epidemic Levels of Drug Resistant Tuberculosis (MDR and XDR-TB) in a High HIV Prevalence Setting in Khayelitsha, South Africa.

Hdl Handle:
http://hdl.handle.net/10144/116338
Title:
Epidemic Levels of Drug Resistant Tuberculosis (MDR and XDR-TB) in a High HIV Prevalence Setting in Khayelitsha, South Africa.
Authors:
Cox, Helen S; McDermid, Cheryl; Azevedo, Virginia; Muller, Odelia; Coetzee, David; Simpson, John; Barnard, Marinus; Coetzee, Gerrit; van Cutsem, Gilles; Goemaere, Eric
Journal:
PloS One
Abstract:
BACKGROUND: Although multidrug-resistant tuberculosis (MDR-TB) is emerging as a significant threat to tuberculosis control in high HIV prevalence countries such as South Africa, limited data is available on the burden of drug resistant tuberculosis and any association with HIV in such settings. We conducted a community-based representative survey to assess the MDR-TB burden in Khayelitsha, an urban township in South Africa with high HIV and TB prevalence. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional survey was conducted among adult clinic attendees suspected for pulmonary tuberculosis in two large primary care clinics, together constituting 50% of the tuberculosis burden in Khayelitsha. Drug susceptibility testing (DST) for isoniazid and rifampicin was conducted using a line probe assay on positive sputum cultures, and with culture-based DST for first and second-line drugs. Between May and November 2008, culture positive pulmonary tuberculosis was diagnosed in 271 new and 264 previously treated tuberculosis suspects (sample enriched with previously treated cases). Among those with known HIV status, 55% and 71% were HIV infected respectively. MDR-TB was diagnosed in 3.3% and 7.7% of new and previously treated cases. These figures equate to an estimated case notification rate for MDR-TB of 51/100,000/year, with new cases constituting 55% of the estimated MDR-TB burden. HIV infection was not significantly associated with rifampicin resistance in multivariate analyses. CONCLUSIONS/SIGNIFICANCE: There is an extremely high burden of MDR-TB in this setting, most likely representing ongoing transmission. These data highlight the need to diagnose drug resistance among all TB cases, and for innovative models of case detection and treatment for MDR-TB, in order to interrupt transmission and control this emerging epidemic.
Affiliation:
Burnet Institute, Melbourne, Australia.
Issue Date:
15-Nov-2010
URI:
http://hdl.handle.net/10144/116338
DOI:
10.1371/journal.pone.0013901
PubMed ID:
21085569
Language:
en
ISSN:
1932-6203
Appears in Collections:
TB

Full metadata record

DC FieldValue Language
dc.contributor.authorCox, Helen Sen
dc.contributor.authorMcDermid, Cherylen
dc.contributor.authorAzevedo, Virginiaen
dc.contributor.authorMuller, Odeliaen
dc.contributor.authorCoetzee, Daviden
dc.contributor.authorSimpson, Johnen
dc.contributor.authorBarnard, Marinusen
dc.contributor.authorCoetzee, Gerriten
dc.contributor.authorvan Cutsem, Gillesen
dc.contributor.authorGoemaere, Ericen
dc.date.accessioned2010-11-25T20:54:44Z-
dc.date.available2010-11-25T20:54:44Z-
dc.date.issued2010-11-15-
dc.identifier.citationEpidemic Levels of Drug Resistant Tuberculosis (MDR and XDR-TB) in a High HIV Prevalence Setting in Khayelitsha, South Africa. 2010, 5 (11):e13901 PLoS ONEen
dc.identifier.issn1932-6203-
dc.identifier.pmid21085569-
dc.identifier.doi10.1371/journal.pone.0013901-
dc.identifier.urihttp://hdl.handle.net/10144/116338-
dc.description.abstractBACKGROUND: Although multidrug-resistant tuberculosis (MDR-TB) is emerging as a significant threat to tuberculosis control in high HIV prevalence countries such as South Africa, limited data is available on the burden of drug resistant tuberculosis and any association with HIV in such settings. We conducted a community-based representative survey to assess the MDR-TB burden in Khayelitsha, an urban township in South Africa with high HIV and TB prevalence. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional survey was conducted among adult clinic attendees suspected for pulmonary tuberculosis in two large primary care clinics, together constituting 50% of the tuberculosis burden in Khayelitsha. Drug susceptibility testing (DST) for isoniazid and rifampicin was conducted using a line probe assay on positive sputum cultures, and with culture-based DST for first and second-line drugs. Between May and November 2008, culture positive pulmonary tuberculosis was diagnosed in 271 new and 264 previously treated tuberculosis suspects (sample enriched with previously treated cases). Among those with known HIV status, 55% and 71% were HIV infected respectively. MDR-TB was diagnosed in 3.3% and 7.7% of new and previously treated cases. These figures equate to an estimated case notification rate for MDR-TB of 51/100,000/year, with new cases constituting 55% of the estimated MDR-TB burden. HIV infection was not significantly associated with rifampicin resistance in multivariate analyses. CONCLUSIONS/SIGNIFICANCE: There is an extremely high burden of MDR-TB in this setting, most likely representing ongoing transmission. These data highlight the need to diagnose drug resistance among all TB cases, and for innovative models of case detection and treatment for MDR-TB, in order to interrupt transmission and control this emerging epidemic.en
dc.language.isoenen
dc.rightsPublished by Public Library of Science, [url]http://www.plosone.org/[/url] Archived on this site by Open Access permissionen
dc.titleEpidemic Levels of Drug Resistant Tuberculosis (MDR and XDR-TB) in a High HIV Prevalence Setting in Khayelitsha, South Africa.en
dc.contributor.departmentBurnet Institute, Melbourne, Australia.en
dc.identifier.journalPloS Oneen

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