Epidemic levels of drug resistant tuberculosis (MDR and XDR-TB) in a high HIV prevalence setting in Khayelitsha, South Africa

 

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dc.contributor.author Cox, Helen S en_ZA
dc.contributor.author McDermid, Cheryl en_ZA
dc.contributor.author Azevedo, Virginia en_ZA
dc.contributor.author Muller, Odelia en_ZA
dc.contributor.author Coetzee, David en_ZA
dc.contributor.author Simpson, John en_ZA
dc.contributor.author Barnard, Marinus en_ZA
dc.contributor.author Coetzee, Gerrit en_ZA
dc.contributor.author van Cutsem, Gilles en_ZA
dc.contributor.author Goemaere, Eric en_ZA
dc.date.accessioned 2016-01-02T05:08:42Z
dc.date.available 2016-01-02T05:08:42Z
dc.date.issued 2010 en_ZA
dc.identifier.citation Cox, H. S., McDermid, C., Azevedo, V., Muller, O., Coetzee, D., Simpson, J., ... & Goemaere, E. (2010). Epidemic levels of drug resistant tuberculosis (MDR and XDR-TB) in a high HIV prevalence setting in Khayelitsha, South Africa. PLOS ONE, 5(11), e13901. doi:10.1371/journal.pone.0013901 en_ZA
dc.identifier.uri http://hdl.handle.net/11427/16191
dc.identifier.uri http://dx.doi.org/10.1371/journal.pone.0013901
dc.description.abstract BACKGROUND: Although multidrug-resistant tuberculosis (MDR-TB) is emerging as a significant threat to tuberculosis control in high HIV prevalence countries such as South Africa, limited data is available on the burden of drug resistant tuberculosis and any association with HIV in such settings. We conducted a community-based representative survey to assess the MDR-TB burden in Khayelitsha, an urban township in South Africa with high HIV and TB prevalence. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional survey was conducted among adult clinic attendees suspected for pulmonary tuberculosis in two large primary care clinics, together constituting 50% of the tuberculosis burden in Khayelitsha. Drug susceptibility testing (DST) for isoniazid and rifampicin was conducted using a line probe assay on positive sputum cultures, and with culture-based DST for first and second-line drugs. Between May and November 2008, culture positive pulmonary tuberculosis was diagnosed in 271 new and 264 previously treated tuberculosis suspects (sample enriched with previously treated cases). Among those with known HIV status, 55% and 71% were HIV infected respectively. MDR-TB was diagnosed in 3.3% and 7.7% of new and previously treated cases. These figures equate to an estimated case notification rate for MDR-TB of 51/100,000/year, with new cases constituting 55% of the estimated MDR-TB burden. HIV infection was not significantly associated with rifampicin resistance in multivariate analyses. Conclusions/Significance There is an extremely high burden of MDR-TB in this setting, most likely representing ongoing transmission. These data highlight the need to diagnose drug resistance among all TB cases, and for innovative models of case detection and treatment for MDR-TB, in order to interrupt transmission and control this emerging epidemic. en_ZA
dc.language.iso eng en_ZA
dc.publisher Public Library of Science en_ZA
dc.rights This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/4.0 en_ZA
dc.source PLoS One en_ZA
dc.source.uri http://journals.plos.org/plosone en_ZA
dc.subject.other Tuberculosis en_ZA
dc.subject.other Extensively drug-resistant tuberculosis en_ZA
dc.subject.other Multi-drug-resistant tuberculosis en_ZA
dc.subject.other HIV en_ZA
dc.subject.other HIV infections en_ZA
dc.subject.other Tuberculosis diagnosis and management en_ZA
dc.subject.other HIV epidemiology en_ZA
dc.subject.other Isoniazid en_ZA
dc.title Epidemic levels of drug resistant tuberculosis (MDR and XDR-TB) in a high HIV prevalence setting in Khayelitsha, South Africa en_ZA
dc.type Journal Article en_ZA
dc.rights.holder © 2010 Cox et al en_ZA
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Department of Public Health and Family Medicine en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Cox, H. S., McDermid, C., Azevedo, V., Muller, O., Coetzee, D., Simpson, J., ... Goemaere, E. (2010). Epidemic levels of drug resistant tuberculosis (MDR and XDR-TB) in a high HIV prevalence setting in Khayelitsha, South Africa. <i>PLoS One</i>, http://hdl.handle.net/11427/16191 en_ZA
dc.identifier.chicagocitation Cox, Helen S, Cheryl McDermid, Virginia Azevedo, Odelia Muller, David Coetzee, John Simpson, Marinus Barnard, Gerrit Coetzee, Gilles van Cutsem, and Eric Goemaere "Epidemic levels of drug resistant tuberculosis (MDR and XDR-TB) in a high HIV prevalence setting in Khayelitsha, South Africa." <i>PLoS One</i> (2010) http://hdl.handle.net/11427/16191 en_ZA
dc.identifier.vancouvercitation Cox HS, McDermid C, Azevedo V, Muller O, Coetzee D, Simpson J, et al. Epidemic levels of drug resistant tuberculosis (MDR and XDR-TB) in a high HIV prevalence setting in Khayelitsha, South Africa. PLoS One. 2010; http://hdl.handle.net/11427/16191. en_ZA
dc.identifier.ris TY - Journal Article AU - Cox, Helen S AU - McDermid, Cheryl AU - Azevedo, Virginia AU - Muller, Odelia AU - Coetzee, David AU - Simpson, John AU - Barnard, Marinus AU - Coetzee, Gerrit AU - van Cutsem, Gilles AU - Goemaere, Eric AB - BACKGROUND: Although multidrug-resistant tuberculosis (MDR-TB) is emerging as a significant threat to tuberculosis control in high HIV prevalence countries such as South Africa, limited data is available on the burden of drug resistant tuberculosis and any association with HIV in such settings. We conducted a community-based representative survey to assess the MDR-TB burden in Khayelitsha, an urban township in South Africa with high HIV and TB prevalence. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional survey was conducted among adult clinic attendees suspected for pulmonary tuberculosis in two large primary care clinics, together constituting 50% of the tuberculosis burden in Khayelitsha. Drug susceptibility testing (DST) for isoniazid and rifampicin was conducted using a line probe assay on positive sputum cultures, and with culture-based DST for first and second-line drugs. Between May and November 2008, culture positive pulmonary tuberculosis was diagnosed in 271 new and 264 previously treated tuberculosis suspects (sample enriched with previously treated cases). Among those with known HIV status, 55% and 71% were HIV infected respectively. MDR-TB was diagnosed in 3.3% and 7.7% of new and previously treated cases. These figures equate to an estimated case notification rate for MDR-TB of 51/100,000/year, with new cases constituting 55% of the estimated MDR-TB burden. HIV infection was not significantly associated with rifampicin resistance in multivariate analyses. Conclusions/Significance There is an extremely high burden of MDR-TB in this setting, most likely representing ongoing transmission. These data highlight the need to diagnose drug resistance among all TB cases, and for innovative models of case detection and treatment for MDR-TB, in order to interrupt transmission and control this emerging epidemic. DA - 2010 DB - OpenUCT DO - 10.1371/journal.pone.0013901 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2010 T1 - Epidemic levels of drug resistant tuberculosis (MDR and XDR-TB) in a high HIV prevalence setting in Khayelitsha, South Africa TI - Epidemic levels of drug resistant tuberculosis (MDR and XDR-TB) in a high HIV prevalence setting in Khayelitsha, South Africa UR - http://hdl.handle.net/11427/16191 ER - en_ZA


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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Except where otherwise noted, this item's license is described as This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.