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. 2014 Sep;18(9):1026-33.
doi: 10.5588/ijtld.13.0749.

Increase in anti-tuberculosis drug resistance in Botswana: results from the fourth National Drug Resistance Survey

H J Menzies  1 , G Moalosi  2 , V Anisimova  3 , V Gammino  1 , C Sentle  2 , M A Bachhuber  4 , E Bile  1 , K Radisowa  5 , O Kachuwaire  6 , J Basotli  5 , T Maribe  5 , R Makombe  4 , J Shepherd  4 , B Kim  1 , T Samandari  1 , S El-Halabi  7 , J Chirenda  2 , K P Cain  1
Affiliations

Increase in anti-tuberculosis drug resistance in Botswana: results from the fourth National Drug Resistance Survey

H J Menzies et al. Int J Tuberc Lung Dis. 2014 Sep.

Abstract

Setting: Although approximately 0.5 million cases of multidrug-resistant tuberculosis (MDR-TB) occur globally each year, surveillance data are limited. Botswana is one of the few high TB burden countries to have carried out multiple anti-tuberculosis drug resistance surveys (in 1995-1996, 1999 and 2002).

Objective: In 2007-2008, we conducted the fourth national survey of anti-tuberculosis drug resistance in Botswana to assess anti-tuberculosis drug resistance, including trends over time. In the previous survey, 0.8% (95%CI 0.4-1.5) of new patients and 10.4% (95%CI 5.6-17.3) of previously treated patients had MDR-TB.

Design: During the survey period, eligible specimens from all new sputum-smear positive TB patients and from all TB patients with history of previous anti-tuberculosis treatment underwent mycobacterial culture and anti-tuberculosis drug susceptibility testing (DST).

Results: Of 924 new TB patients and 137 with previous anti-tuberculosis treatment with DST results, respectively 23 (2.5%, 95%CI 1.6-3.7) and 9 (6.6%, 95%CI 3.3-11.7) had MDR-TB. The proportion of new TB patients with MDR-TB has tripled in Botswana since the previous survey.

Conclusion: Combatting drug-resistant TB will require the scale-up of MDR-TB diagnosis and treatment to prevent the transmission of MDR-TB and strengthening of general TB control to prevent the emergence of resistance.

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Conflict of interest statement

Conflict of interest: none declared.

Figures

Figure 1
Figure 1
Enrollment in Botswana’s fourth national anti-tuberculosis drug resistance survey, 2007–2008. * Initial eligibility for the DRS was decided by district/local laboratories, which selected all smear-positive diagnostic (month 0) specimens from new patients and all diagnostic (month 0) specimens (smear-positive or smear-negative) from retreatment patients and sent these to the NTRL for inclusion in the DRS. Final eligibility was determined at the NTRL. NTRL = National TB Reference Laboratory; DRS = drug resistance survey; MOTT = mycobacteria other than tuberculosis; DST = drug susceptibility testing.
Figure 2
Figure 2
Trends in first-line anti-tuberculosis drug resistance among new patients in Botswana’s national anti-tuberculosis drug resistance surveys, 1995–2008. INH =isoniazid; RMP =rifampicin; EMB = ethambutol; SM = streptomycin.
Figure 3
Figure 3
Trends in proportion (and 95% confidence intervals) of patients with MDR-TB by patient treatment category in Botswana’s national anti-tuberculosis drug resistance surveys, 1995–2008. MDR-TB = multidrug-resistant tuberculosis.
See this image and copyright information in PMC

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