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Meta-Analysis
. 2013 Nov;23(3):271-82.
doi: 10.4314/ejhs.v23i3.10.

A meta-analysis of drug resistant tuberculosis in Sub-Saharan Africa: how strongly associated with previous treatment and HIV co-infection?

Asres Berhan  1 , Yifru Berhan, Desalegn Yizengaw
Affiliations
Meta-Analysis

A meta-analysis of drug resistant tuberculosis in Sub-Saharan Africa: how strongly associated with previous treatment and HIV co-infection?

Asres Berhan et al. Ethiop J Health Sci. 2013 Nov.

Abstract

Background: In Sub-Saharan Africa, the fight against tuberculosis (TB) has encountered a great challenge because of the emergence of drug resistant TB strains and the high prevalence of HIV infection. The aim of this meta-analysis was to determine the association of drug-resistant TB with anti-TB drug treatment history and HIV co-infection.

Methods: After electronic based literature search in the databases of Medline, HINARI, EMBASE and the Cochrane library, article selection and data extraction were carried out. HIV co-infection and previous history of TB treatment were used as predictors for the occurrence of any anti-TB drug resistant or multiple drug resistant TB (MDR-TB). The risk ratios for each included study and for the pooled sample were computed using the random-effects model. Heterogeneity test, sensitivity analyses and funnel plots were also done.

Results: The pooled analysis showed that the risk of developing drug-resistant TB to at least one anti-TB drug was about 3 times higher in individuals who had a previous history of anti-TB treatment than new TB cases. The risk of having MDR-TB in previously anti-TB treated TB cases was more than 5-fold higher than that of new TB cases. Resistance to Ethambutol and Rifampicin was more than fivefold higher among the previously treated with anti-TB drugs. However, HIV infection was not associated with drug-resistant TB.

Conclusion: There was a strong association of previous anti-TB treatment with MDR-TB. Primary treatment warrants special emphasis, and screening for anti-TB drugs sensitivity has to be strengthened.

Keywords: HIV; Sub-Saharan Africa; drug resistance; meta-analysis; previous treatment; tuberculosis.

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Figures

Figure 1
Figure 1
Flow diagram to show study selection process, Sub-Saharan Africa
Figure 2
Figure 2
Risk ratio of any anti-TB drug resistance in relation to HIV status (HIV positives vs HIV negatives), a metaanalysis in Sub-Saharan Africa.
Figure 3
Figure 3
Risk ratio of multidrug resistant TB (MDR-TB) in relation to HIV status (HIV positives vs HIV negatives), a meta-analysis in Sub-Saharan Africa.
Figure 4
Figure 4
Risk ratio of any anti-TB drug resistance in relation to previous history of anti-TB treatment (previously TB treated vs New TB cases), a meta-analysis in Sub-Saharan Africa.
Figure 5
Figure 5
Risk ratio of multidrug resistant TB (MDR-TB) in relation to previous history of anti-TB treatment (previously TB treated vs New TB cases), a meta-analysis in Sub-Saharan Africa
See this image and copyright information in PMC

References

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    1. World Health Organization (WHO), author The evolving threat of antimicrobial resistance: options for action. 2012. http://whqlibdoc.who.int/publications/2012/pdf.
    1. The WHO/IUATLD, author. Global Project on Antituberculosis Drug Resistance Surveillance. Anti-Tuberculosis drug resistance in the world: Report 4. 2002–2007. http://www.who.int/tb/publications/2008/pdf.

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