SummaryBackgroundGlobally,
per-capita, South Africa reports a disproportionately high number of
cases of multidrug-resistant (MDR) tuberculosis and extensively
drug-resistant (XDR) tuberculosis. We sought to estimate the prevalence
of resistance to tuberculosis drugs in newly diagnosed and retreated
patients with tuberculosis provincially and nationally, and compared
these with the 2001–02 estimates. MethodsA
cross-sectional survey was done between June 15, 2012–June 14, 2014,
using population proportionate randomised cluster sampling in the nine
provinces in South Africa. 343 clusters were included, ranging between
31 and 48 per province. A patient was eligible for inclusion in the
survey if he or she presented as a presumptive case during the intake
period at a drug resistance survey enrolling facility. Consenting
participants (≥18 years old) completed a questionnaire and had a sputum
sample tested for resistance to first-line and second-line drugs.
Analysis was by logistic regression with robust SEs, inverse probability
weighted against routine data, and estimates were derived using a
random effects model. Findings101 422
participants were tested in 2012–14. Nationally, the prevalence of MDR
tuberculosis was 2·1% (95% CI 1·5–2·7) among new tuberculosis cases and
4·6% (3·2–6·0) among retreatment cases. The provincial point prevalence
of MDR tuberculosis ranged between 1·6% (95% CI 0·9–2·9) and 5·1%
(3·7–7·0). Overall, the prevalence of rifampicin-resistant tuberculosis
(4·6%, 95% CI 3·5–5·7) was higher than the prevalence of MDR
tuberculosis (2·8%, 2·0–3·6; p=0·01). Comparing the current survey with
the previous (2001–02) survey, the overall MDR tuberculosis prevalence
was 2·8% versus 2·9% and prevalance of rifampicin-resistant tuberculosis
was 3·4% versus 1·8%, respectively. The prevalence of isoniazid
mono-resistant tuberculosis was above 5% in all provinces. The
prevalence of ethionamide and pyrazinamide resistance among MDR
tuberculosis cases was 44·7% (95% CI 25·9–63·6) and 59·1% (49·0–69·1),
respectively. The prevalence of XDR tuberculosis was 4·9% (95% CI
1·0–8·8). Nationally, the estimated numbers of cases of
rifampicin-resistant tuberculosis, MDR tuberculosis, and isoniazid
mono-resistant tuberculosis for 2014 were 13 551, 8249, and 17 970,
respectively. InterpretationThe
overall prevalence of MDR tuberculosis in South Africa in 2012–14 was
similar to that in 2001–02; however, prevalence of rifampicin-resistant
tuberculosis almost doubled among new cases. Furthermore, the high
prevalence of isoniazid mono-resistant tuberculosis, not routinely
screened for, and resistance to second-line drugs has implications for
empirical management. FundingPresident's
Emergency Plan for AIDS Relief through the Centers for Disease Control
and Prevention under the terms of 1U19GH000571. Source: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2818%2930222-6/fulltext" rel="nofollow - http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30222-6/fulltext
[Technophobe interpretation: Things are slowly but inexorably growing worse. Rifampicin and isoniazid are the basis of standard TB treatments.]
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