Prevalence of drug-resistant tuberculosis in Zimbabwe: A health facility-based cross-sectional survey

• Published in: International journal of infectious diseases Vol. 87; pp. 119 - 125
• Main Authors: Timire, Collins, Metcalfe, John Z., Chirenda, Joconiah, Scholten, Jerod N., Manyame-Murwira, Barbara, Ngwenya, Mkhokheli, Matambo, Ronnie, Charambira, Kelvin, Mutunzi, Herbert, Kalisvaart, Nico, Sandy, Charles
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01.10.2019; Elsevier
• Subjects: Adolescent; Adult; Aged; Anti-Bacterial Agents - pharmacology; Child; Cross-Sectional Studies; Drug Resistance, Bacterial; Drug resistant TB; Female; Gene Xpert; Health Facilities; Humans; Isoniazid - pharmacology; Male; MDR; Microbial Sensitivity Tests; Middle Aged; Mycobacterium tuberculosis - drug effects; Mycobacterium tuberculosis - genetics; Mycobacterium tuberculosis - isolation & purification; Prevalence; Previously treated TB; Rifampicin resistant TB; Rifampin - pharmacology; Risk Factors; Sensitivity and Specificity; Sputum - microbiology; Surveys and Questionnaires; Tuberculosis, Multidrug-Resistant - epidemiology; Tuberculosis, Multidrug-Resistant - microbiology; Young Adult; Zimbabwe; Zimbabwe - epidemiology; Zimbabwe; Drug resistant TB; Gene Xpert; Previously treated TB; Zimbabwe; MDR; Rifampicin resistant TB
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2019.07.021

•The prevalence of RR-TB was [4.0% (95% CI, 2.9, 5.4%) and 14.2% (95% CI, 8.9, 21.1%)] among new and retreatment patients, respectively.•The prevalence of MDR-TB was 2.0% (95% CI, 1.3, 3.1%) and 6.4% (95% CI, 2.4, 10.3%) among new and retreatment TB patients, respectively.•Weighted prevalence of RR-TB and MDR-TB among new TB patients were 4.6% (95% CI, 3.0, 6.2%) and 1.8% (95% CI, 1.0, 2.5%), respectively.•Risk factors for RR-TB included prior TB treatment, self-reported HIV infection, travel outside Zimbabwe for >one month (univariate), and age <15 years.•The prevalence of MDR-TB has remained stable since the subnational survey in 1994. To determine the prevalence of resistance to rifampicin alone; rifampicin and isoniazid, and second-line anti-TB drugs among sputum smear-positive tuberculosis patients in Zimbabwe. A health facility-based cross-sectional survey. In total, 1114 (87.6%) new and 158 (12.4%) retreatment TB patients were enrolled. MTB was confirmed by Xpert MTB/RIF among 1184 (93%) smear-positive sputum samples. There were 64 samples with Xpert MTB/RIF-determined rifampicin resistance. However, two were rifampicin susceptible on phenotypic drug susceptibility testing. The prevalence of RR-TB was [4.0% (95% CI, 2.9, 5.4%), n=42/1043) and 14.2% (95% CI, 8.9, 21.1%; n=20/141) among new and retreatment patients, respectively. The prevalence of MDR-TB was 2.0% (95% CI, 1.3, 3.1%) and 6.4% (95% CI, 2.4, 10.3%) among new and retreatment TB patients, respectively. Risk factors for RR-TB included prior TB treatment, self-reported HIV infection, travel outside Zimbabwe for ≥one month (univariate), and age <15 years. Having at least a secondary education was protective against RR-TB. The prevalence of MDR-TB in Zimbabwe has remained stable since the 1994 subnational survey. However, the prevalence of rifampicin mono-resistance was double that of MDR-TB.