Detection and management of drug-resistant tuberculosis in HIV-infected patients in lower-income countries.

Ballif, Marie; Nhandu, V; Wood, R; Dusingize, J C; Carter, E J; Cortes, C P; McGowan, C C; Diero, L; Graber, Claire; Renner, L; Hawerlander, D; Kiertiburanakul, S; Du, Q T; Sterling, T R; Egger, Matthias; Fenner, L (2014). Detection and management of drug-resistant tuberculosis in HIV-infected patients in lower-income countries. International journal of tuberculosis and lung disease, 18(11), pp. 1327-1336. International Union Against Tuberculosis and Lung Disease IUATLD 10.5588/ijtld.14.0106

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SETTING

Drug resistance threatens tuberculosis (TB) control, particularly among human immunodeficiency virus (HIV) infected persons.

OBJECTIVE

To describe practices in the prevention and management of drug-resistant TB under antiretroviral therapy (ART) programs in lower-income countries.

DESIGN

We used online questionnaires to collect program-level data on 47 ART programs in Southern Africa (n = 14), East Africa (n = 8), West Africa (n = 7), Central Africa (n = 5), Latin America (n = 7) and the Asia-Pacific (n = 6 programs) in 2012. Patient-level data were collected on 1002 adult TB patients seen at 40 of the participating ART programs.

RESULTS

Phenotypic drug susceptibility testing (DST) was available in 36 (77%) ART programs, but was only used for 22% of all TB patients. Molecular DST was available in 33 (70%) programs and was used in 23% of all TB patients. Twenty ART programs (43%) provided directly observed therapy (DOT) during the entire course of treatment, 16 (34%) during the intensive phase only, and 11 (23%) did not follow DOT. Fourteen (30%) ART programs reported no access to second-line anti-tuberculosis regimens; 18 (38%) reported TB drug shortages.

CONCLUSIONS

Capacity to diagnose and treat drug-resistant TB was limited across ART programs in lower-income countries. DOT was not always implemented and drug supplies were regularly interrupted, which may contribute to the global emergence of drug resistance.

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