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

Publication

Author(s):

Ballif M, Nhandu V, Wood R, Dusingize JC, Carter EJ, Cortes CP, McGowan CC, Diero L, Graber C, Renner L, Hawerlander D, Kiertiburanakul S, Du QT, Sterling TR, Egger M, Fenner L; International epidemiological Databases to Evaluate AIDS (IeDEA).

Pub Title:

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

Pub Date:

Nov 30 2014

Journal:

Title: 
International Journal of Tuberculosis and Lung Disease
Link: 
http://www.ingentaconnect.com/content/iuatld/ijtld/2014/00000018/00000011/art00013?token=00541a58ee4fbf01285c5f3b3b4746667670342545232b5f246c4f582a2f4876753375686f499682d7da

PubMed: 25299866
Pub PDF:

Abstract
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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Citation:

Ballif M, Nhandu V, Wood R, Dusingize JC, Carter EJ, Cortes CP, McGowan CC, Diero L, Graber C, Renner L, Hawerlander D, Kiertiburanakul S, Du QT, Sterling TR, Egger M, Fenner L; International epidemiological Databases to Evaluate AIDS (IeDEA). Detection and management of drug-resistant tuberculosis in HIV-infected patients in lower-income countries. Int J Tuberc Lung Dis. 2014 Nov;18(11):1327-36. doi: 10.5588/ijtld.14.0106. PubMed PMID: 25299866.