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. 2014 Nov;18(11):1327-36.
doi: 10.5588/ijtld.14.0106.

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

M Ballif  1 , V Nhandu  2 , R Wood  3 , J C Dusingize  4 , E J Carter  5 , C P Cortes  6 , C C McGowan  7 , L Diero  5 , C Graber  1 , L Renner  8 , D Hawerlander  9 , S Kiertiburanakul  10 , Q T Du  11 , T R Sterling  7 , M Egger  1 , L Fenner  11 ; International epidemiological Databases to Evaluate AIDS (IeDEA)
Collaborators, Affiliations

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

M Ballif et al. Int J Tuberc Lung Dis. 2014 Nov.

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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Conflict of interest statement

Competing interests

TRS reports grant support to Vanderbilt University from Pfizer, Bristol Myers Squibb and Virco. TRS has acted as a consultant to Sanofi-Aventis and as a member of a Data Safety Monitoring Board for Otsuka. All other authors declare that they have no competing interests.

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