Journal
INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE
Volume 16, Issue 7, Pages 967-973Publisher
INT UNION AGAINST TUBERCULOSIS LUNG DISEASE (I U A T L D)
DOI: 10.5588/ijtld.11.0122
Keywords
multidrug resistance; HIV; drug susceptibility testing; isoniazid; rifampicin
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Funding
- Colt Foundation, UK
- Consortium to Respond Effectively to the AIDS/TB Epidemics [CREATE], through a grant from the Bill and Melinda Gates Foundation
- US National Institutes of Health [AI077486]
- Biostatistics Core of CREATE
- US National Institutes of Health
- National Institute of Health Fogarty ICORTA-TB/AIDS [5U2RTW007370, 5U2RTW007373]
- public health career scientist award from the Department of Health, UK
- Medical Research Council [G0700837] Funding Source: researchfish
- National Institute for Health Research [PHCS/03/01] Funding Source: researchfish
- MRC [G0700837] Funding Source: UKRI
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SETTING AND OBJECTIVE: To describe trends in drug-resistant tuberculosis (TB) in two gold-mining work-forces, South Africa, 2002-2008. DESIGN: TB programme data analysis. RESULTS: TB case notification rates decreased between 2002 and 2008 from 4006 to 3018 per 100000 and from 3192 to 2468/100 000 for Companies A and B, respectively. Human immunodeficiency virus (HIV) prevalence exceeded 80% in TB episodes with known status. The proportion of TB episodes with multidrug-resistant TB (MDR-TB) increased from 6/129 (4.7%) to 17/85 (20.0%) among previously treated cases, and from 4/38 (10.4%) to 7/28 (25.0%) in Companies A and B, respectively (tests for trend, Company A, P < 0.001; Company B, P = 0.304). Case notifications of MDR-TB increased during 2002-2008 from 39.8 to 122.9/100 000/year in Company A and from 7.8 to 96.8/100 000/year in Company B. Coverage of second-line drug susceptibility testing (DST) among MDR-TB episodes was low. Previous treatment exposure was a strong risk factor for MDR-TB (prevalence ratio 8.78, 95%CI 5.94-12.97 in previously treated vs. untreated individuals). CONCLUSION: Despite decreasing TB notifications overall, MDR-TB notifications and proportions of episodes with MDR-TB increased in the larger company. Cure must be ensured in first episodes to prevent acquired resistance. Improved coverage of culture, DST and HIV testing is required to allow treatment to be optimised.
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