Abstract:
BACKGROUND : The World Health Organization End TB Strategy targets for 2035 are ambitious
and drug resistant tuberculosis is an important barrier, particularly in Africa, home to over a
billion people.
OBJECTIVE : We sought to review the current status of drug resistant tuberculosis in Africa and
highlight key areas requiring improvement.
METHODS : Available data from 2016 World Health Organization global tuberculosis database
were extracted and analysed using descriptive statistics.
RESULTS : The true burden of drug resistant tuberculosis on the continent is poorly described
with only 51% of countries having a formal survey completed. In the absence of this data,
modelled estimates were used and reported 92 629 drug resistant tuberculosis cases with 42%
of these occurring in just two countries: Nigeria and South Africa. Of the cases estimated, the
majority of patients (70%) were not notified, representing ‘missed cases’. Mortality among
patients with multi-drug resistant tuberculosis was 21%, and was 43% among those with
extensively drug resistant tuberculosis. Policies on the adoption of new diagnostic tools was
poor and implementation was lacking. A rifampicin result was available for less than 10% of
tuberculosis cases in 23 of 47 countries. Second-line drug resistance testing was available in
only 60% of countries. The introduction of the short multi-drug resistant tuberculosis regimen
was a welcome development, with 40% of countries having implemented it in 2016. Bedaquiline
has also been introduced in several countries.
CONCLUSION : Drug resistant tuberculosis is largely missed in Africa and this threatens prospects
to achieve the 2035 targets. Urgent efforts are required to confirm the true burden of drug resistant tuberculosis in Africa. Adoption of new tools and drugs is essential if the 2035 targets
are to be met.
