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.authorCox, Helen Sen_ZA
dc.contributor.authorMcDermid, Cherylen_ZA
dc.contributor.authorAzevedo, Virginiaen_ZA
dc.contributor.authorMuller, Odeliaen_ZA
dc.contributor.authorCoetzee, Daviden_ZA
dc.contributor.authorSimpson, Johnen_ZA
dc.contributor.authorBarnard, Marinusen_ZA
dc.contributor.authorCoetzee, Gerriten_ZA
dc.contributor.authorvan Cutsem, Gillesen_ZA
dc.contributor.authorGoemaere, Ericen_ZA
dc.date.accessioned2016-01-02T05:08:42Z
dc.date.available2016-01-02T05:08:42Z
dc.date.issued2010en_ZA
dc.description.abstractBACKGROUND: 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.identifier.apacitationCox, 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/11427/16191en_ZA
dc.identifier.chicagocitationCox, 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/11427/16191en_ZA
dc.identifier.citationCox, 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.0013901en_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
dc.identifier.urihttp://hdl.handle.net/11427/16191
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0013901
dc.identifier.vancouvercitationCox 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.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDepartment of Public Health and Family Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis 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.holder© 2010 Cox et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherTuberculosisen_ZA
dc.subject.otherExtensively drug-resistant tuberculosisen_ZA
dc.subject.otherMulti-drug-resistant tuberculosisen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherHIV infectionsen_ZA
dc.subject.otherTuberculosis diagnosis and managementen_ZA
dc.subject.otherHIV epidemiologyen_ZA
dc.subject.otherIsoniaziden_ZA
dc.titleEpidemic levels of drug resistant tuberculosis (MDR and XDR-TB) in a high HIV prevalence setting in Khayelitsha, South Africaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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