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PA-052
MULTIDRUG-RESISTANT TUBERCULOSIS (MDR-TB): AN EMERGING PROBLEM IN WEST AFRICA
  1. Jacob Otu1,
  2. Florian Gehre1,2,
  3. Dezemon Zingue3,
  4. Samuel Kudzawu4,
  5. Audrey Forson4,
  6. Morto Mane5,
  7. Paulo Rabna5,
  8. Bassirou Diarra6,
  9. Salako Kayede7,
  10. Emmanuel Adebiyi7,
  11. Aderemi Kehinde7,
  12. Nneka Onyejepu8,
  13. Catherine Onubogu8,
  14. Emmanuel Idigbe8,
  15. Awa Ba9,
  16. Aissatou Diallo9,
  17. Souleymane Mboup9,
  18. Kodjo Disse10,
  19. Gerard Kadanga10,
  20. Yaotse Dagnra10,
  21. Ignatius Baldeh11,
  22. Tumani Corrah1,
  23. Bouke De Jong2,
  24. Martin Antonio1
  1. 1MRC, The Gambia
  2. 2ITM Antwerp, Belgium
  3. 3Centre Muraz Research Institute, Burkina Faso
  4. 4Korle-Bu Teaching Hospital, Ghana
  5. 5Laboratório Nacional de Saúde Pública, Guinea-Bissau
  6. 6SEREFO (HIV/TB RESEARCH and Training Centre) Bamako, Mali
  7. 7Zonal TB Reference Laboratory, UCH, Nigeria
  8. 8NIMR, Nigeria
  9. 9University Hospital Centre Le Dantec, Senegal
  10. 10Sylvanus Olympio Teaching Hospital, Lomé, Togo
  11. 11National Public Health Laboratories, Ministry of Health, The Gambia

Abstract

Background Multidrug-resistant tuberculosis (MDR-TB) remains a clear threat to TB control. There is a paucity of data on DR-TB for many countries especially in sub-Saharan Africa. The study was undertaken to measure the prevalence of DR-TB, including MDR-TB, from West Africa.

Methods Mycobacterial isolates were obtained from consecutive new and previously treated TB patients from Burkina Faso, Ghana, Guinea-Bissau, Mali, Nigeria, Senegal, The Gambia and Togo from December 2012 to December 2014. Phenotypic drug susceptibility testing to first- and second-line anti-TB drugs was performed using BACTEC MGIT 960 system.

Results Viable isolates from a total of 44% (416/950) new and 56% (534/950) previously treated TB patients were included. HIV results were available for 599 (63%) with estimated HIV-TB co-infection of 21% (95% CI: 18.2−24.9%). Pooled estimate of any DR-TB prevalence among new TB patients was 20% (95% CI: 16.4−24.4%) while for MDR-TB this was 6% (95% CI: 4.1−9.0%). Among previously treated TB patients, these were 53% (95% CI: 48.3−56.9%) and 34% (95% CI: 30.1−38.3%), respectively. Significant factor for the development of MDR-TB was the history of previous anti-TB treatment (Crude OR=0.13; 95% CI: 0.08−0.20; p=<0.001).

Mono-resistance was detected in 12% (95% CI: 10.2−14.5%) with the highest resistance to streptomycin 6% (95% CI: 4.8−7.9%). Pooled estimate of pre-XDR-TB prevalence rate among MDR-TB patients was 21% (95% CI: 15.2−26.9%). Estimated resistance to ofloxacin, kanamycin, capreomycin and kanamycin and capreomycin were 7% (95% CI: 3.5−10.9%), 2% (95% CI: 0.6−5.1%), 9% (95% CI: 5.8−14.5%), and 3% (95% CI: 0.8−5.8%), respectively.

Conclusions The reported prevalence of MDR-TB and pre-XDR-TB are high compared to WHO estimates. Resistance to streptomycin may indicate a high risk of failure for the WHO standard regimen. MDR-TB patients with resistance to either the fluoroquinolone or injectables may have suboptimal response; thus the need for continuous surveillance of TB resistance.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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