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

International epidemiological Databases to Evaluate AIDS (IeDEA)

Research output: Contribution to journalArticle

4 Citations (Scopus)

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 drugresistant TB was limited across ART programs in lowerincome countries. DOT was not always implemented and drug supplies were regularly interrupted, which may contribute to the global emergence of drug resistance.

Original languageEnglish
Pages (from-to)1327-1336
Number of pages10
JournalInternational Journal of Tuberculosis and Lung Disease
Volume18
Issue number11
DOIs
StatePublished - Nov 1 2014

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Multidrug-Resistant Tuberculosis
HIV
Tuberculosis
Directly Observed Therapy
Therapeutics
Drug Resistance
Pharmaceutical Preparations
Central Africa
Southern Africa
Eastern Africa
Western Africa
Latin America

Keywords

  • Africa
  • ART programs
  • Asia
  • Latin America
  • MDR-TB

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases

Cite this

Detection and management of drug-resistant tuberculosis in HIV-infected patients in lower-income countries. / International epidemiological Databases to Evaluate AIDS (IeDEA).

In: International Journal of Tuberculosis and Lung Disease, Vol. 18, No. 11, 01.11.2014, p. 1327-1336.

Research output: Contribution to journalArticle

International epidemiological Databases to Evaluate AIDS (IeDEA). / Detection and management of drug-resistant tuberculosis in HIV-infected patients in lower-income countries. In: International Journal of Tuberculosis and Lung Disease. 2014 ; Vol. 18, No. 11. pp. 1327-1336.
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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 drugresistant TB was limited across ART programs in lowerincome 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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author = "{International epidemiological Databases to Evaluate AIDS (IeDEA)} and M. Ballif and V. Nhandu and R. Wood and Dusingize, {J. C.} and Carter, {E. J.} and Cortes, {C. P.} and McGowan, {C. C.} and L. Diero and C. Graber and L. Renner and D. Hawerlander and S. Kiertiburanakul and Du, {Q. T.} and Sterling, {T. R.} and M. Egger and L. Fenner and S. Ajayi and K. Anastos and M. Ballif and J. Bashi and W. Bishai and A. Boulle and P. Braitstein and G. Carriquiry and Carter, {J. E.} and P. Cegielski and C. Chimbetete and J. Conrad and Cortes, {C. P.} and Davies, {M. A.} and L. Diero and S. Duda and N. Durier and Dusingize, {J. C.} and M. Egger and Eboua, {T. F.} and L. Fenner and A. Gasser and E. Geng and L. Hardwicke and C. Hoffmann and R. Huebner and N. Kancheya and S. Kiertiburanakul and P. Kim and D. Lameck and V. Leroy and C. Lewden and Kara Wools-Kaloustian and Constantin Yiannoutsos",
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AU - McGowan, C. C.

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AU - Kiertiburanakul, S.

AU - Du, Q. T.

AU - Sterling, T. R.

AU - Egger, M.

AU - Fenner, L.

AU - Ajayi, S.

AU - Anastos, K.

AU - Ballif, M.

AU - Bashi, J.

AU - Bishai, W.

AU - Boulle, A.

AU - Braitstein, P.

AU - Carriquiry, G.

AU - Carter, J. E.

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AU - Conrad, J.

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AU - Davies, M. A.

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AU - Dusingize, J. C.

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AU - Eboua, T. F.

AU - Fenner, L.

AU - Gasser, A.

AU - Geng, E.

AU - Hardwicke, L.

AU - Hoffmann, C.

AU - Huebner, R.

AU - Kancheya, N.

AU - Kiertiburanakul, S.

AU - Kim, P.

AU - Lameck, D.

AU - Leroy, V.

AU - Lewden, C.

AU - Wools-Kaloustian, Kara

AU - Yiannoutsos, Constantin

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N2 - 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 drugresistant TB was limited across ART programs in lowerincome countries. DOT was not always implemented and drug supplies were regularly interrupted, which may contribute to the global emergence of drug resistance.

AB - 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 drugresistant TB was limited across ART programs in lowerincome countries. DOT was not always implemented and drug supplies were regularly interrupted, which may contribute to the global emergence of drug resistance.

KW - Africa

KW - ART programs

KW - Asia

KW - Latin America

KW - MDR-TB

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