Prevalence of drug-resistant tuberculosis and imputed burden in South Africa : a national and sub-national cross-sectional survey

Show simple item record Ismail, Nazir Ahmed Mvusi, Lindiwe Nanoo, Ananta Dreyer, Andries Omar, Shaheed V. Babatunde, Sanni Molebatsi, Thabo Van der Walt, Martie Adelekan, Adeboye Deyde, Varough Ihekweazu, Chikwe Madhi, S.A. 2018-05-14T11:21:50Z 2018-07
dc.description.abstract BACKGROUND : Globally, 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. METHODS : A 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. FINDINGS : 101 422 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. INTERPRETATION : The 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. en_ZA
dc.description.department Medical Microbiology en_ZA
dc.description.embargo 2019-07-01
dc.description.librarian hj2018 en_ZA
dc.description.sponsorship President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention under the terms of 1U19GH000571. en_ZA
dc.description.uri en_ZA
dc.identifier.citation Ismail, N.A., Mvusi, L., Nanoo, A. et al. 2018, 'Prevalence of drug-resistant tuberculosis and imputed burden in South Africa: a national and sub-national cross-sectional survey', Lancet Infectious Diseases, vol. 18, no. 7, pp. 779-787. en_ZA
dc.identifier.issn 1473-3099 (print)
dc.identifier.issn 1474-4457 (online)
dc.identifier.other 10.1016/S1473-3099(18)30222-6
dc.language.iso en en_ZA
dc.publisher Elsevier en_ZA
dc.rights © 2018 Elsevier Ltd. All rights reserved. Notice : this is the author’s version of a work that was accepted for publication in Lancet Infectious Diseases . Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. A definitive version was subsequently published in Lancet Infectious Diseases, vol. 18, no. 7, pp. 779-787, 2018. doi : 10.1016/S1473-3099(18)30222-6. en_ZA
dc.subject Multidrug-resistant tuberculosis (MDR-TB) en_ZA
dc.subject Extensively drug-resistant tuberculosis (XDR-TB) en_ZA
dc.subject South Africa (SA) en_ZA
dc.subject Rifampicin-resistant tuberculosis en_ZA
dc.subject Isoniazid mono-resistant tuberculosis en_ZA
dc.subject Tuberculosis drug resistance en_ZA
dc.title Prevalence of drug-resistant tuberculosis and imputed burden in South Africa : a national and sub-national cross-sectional survey en_ZA
dc.type Postprint Article en_ZA

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