Anti-tuberculosis drug resistance among new and previously treated sputum smear-positive tuberculosis patients in Uganda: results of the first national survey.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: Electronic-Print Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Data Collection* ; Drug Resistance, Bacterial*; Antitubercular Agents/*pharmacology ; Sputum/*microbiology ; Tuberculosis/*drug therapy ; Tuberculosis/*epidemiology; Adolescent ; Adult ; Antitubercular Agents/therapeutic use ; Drug Resistance, Multiple ; Female ; HIV Infections/complications ; Humans ; Male ; Middle Aged ; Risk ; Tuberculosis/complications ; Uganda/epidemiology ; World Health Organization ; Young Adult

Background: Multidrug resistant and extensively drug resistant tuberculosis (TB) have become major threats to control of tuberculosis globally. The rates of anti-TB drug resistance in Uganda are not known. We conducted a national drug resistance survey to investigate the levels and patterns of resistance to first and second line anti-TB drugs among new and previously treated sputum smear-positive TB cases.
Methods: Sputum samples were collected from a nationally representative sample of new and previously treated sputum smear-positive TB patients registered at TB diagnostic centers during December 2009 to February 2011 using a weighted cluster sampling method. Culture and drug susceptibility testing was performed at the national TB reference laboratory.
Results: A total of 1537 patients (1397 new and 140 previously treated) were enrolled in the survey from 44 health facilities. HIV test result and complete drug susceptibility testing (DST) results were available for 1524 (96.8%) and 1325 (85.9%) patients, respectively. Of the 1209 isolates from new cases, resistance to any anti-TB drug was 10.3%, 5% were resistant to isoniazid, 1.9% to rifampicin, and 1.4% were multi drug resistant. Among the 116 isolates from previously treated cases, the prevalence of resistance was 25.9%, 23.3%, 12.1% and 12.1% respectively. Of the 1524 patients who had HIV testing 469 (30.7%) tested positive. There was no association between anti-TB drug resistance (including MDR) and HIV infection.
Conclusion: The prevalence of anti-TB drug resistance among new patients in Uganda is low relative to WHO estimates. The higher levels of MDR-TB (12.1%) and resistance to any drug (25.3%) among previously treated patients raises concerns about the quality of directly observed therapy (DOT) and adherence to treatment. This calls for strengthening existing TB control measures, especially DOT, routine DST among the previously treated TB patients or periodic drug resistance surveys, to prevent and monitor development and transmission of drug resistant TB.

Int J Tuberc Lung Dis. 1999 Jan;3(1):4-11. (PMID: 10094163)
J Clin Microbiol. 1993 Feb;31(2):406-9. (PMID: 8381814)
S Afr Med J. 2000 Apr;90(4):381-6. (PMID: 10957924)
Int J Tuberc Lung Dis. 2010 Aug;14(8):967-72. (PMID: 20626940)
PLoS One. 2013;8(1):e54587. (PMID: 23349933)
Int J Tuberc Lung Dis. 1999 Sep;3(9):810-5. (PMID: 10488890)
Lancet. 2009 May 30;373(9678):1861-73. (PMID: 19375159)
Respir Res. 2005 Nov 08;6:134. (PMID: 16277659)
N Engl J Med. 2001 Apr 26;344(17):1294-303. (PMID: 11320389)
PLoS Med. 2009 Sep;6(9):e1000146. (PMID: 19753109)
Future Microbiol. 2011 Sep;6(9):1067-82. (PMID: 21958145)
AIDS. 1996 Mar;10(3):299-309. (PMID: 8882670)
Ann Intern Med. 2008 Jul 15;149(2):123-34. (PMID: 18626051)
Trop Med Int Health. 2004 Jan;9(1):25-40. (PMID: 14728604)
N Engl J Med. 1995 Feb 2;332(5):336-7. (PMID: 7816080)
Biometrics. 1992 Jun;48(2):577-85. (PMID: 1637980)
AIDS. 1995 Jun;9(6):577-83. (PMID: 7662196)
East Afr Med J. 2000 Feb;77(2):111-5. (PMID: 10774085)
PLoS One. 2011 Jan 10;6(1):e16130. (PMID: 21249225)
Int J Tuberc Lung Dis. 1997 Jun;1(3):220-4. (PMID: 9432367)
J Infect Dis. 2007 Aug 15;196 Suppl 1:S86-107. (PMID: 17624830)
Am J Respir Crit Care Med. 1999 Feb;159(2):468-72. (PMID: 9927359)
Arch Intern Med. 2003 May 12;163(9):1009-21. (PMID: 12742798)
PLoS One. 2012;7(11):e48599. (PMID: 23139799)
Int J Tuberc Lung Dis. 2007 Feb;11(2):189-94. (PMID: 17263290)
Tuber Lung Dis. 1995 Oct;76(5):455-9. (PMID: 7496009)
Lancet. 2004 Oct 2-8;364(9441):1244-51. (PMID: 15464185)

United States PEPFAR

0 (Antitubercular Agents)

Date Created: 20130813 Date Completed: 20140318 Latest Revision: 20231106

20231215

PMC3731251

10.1371/journal.pone.0070763

23936467