Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 20, Number 1—January 2014
Dispatch

Drug-Resistant Tuberculosis in High-Risk Groups, Zimbabwe

John Z. MetcalfeComments to Author , Salome Makumbirofa, Beauty Makamure, Charles Sandy, Wilbert Bara, Stanley Mungofa, Philip C. Hopewell, and Peter Mason
Author affiliations: Curry International Tuberculosis Center–San Francisco General Hospital, San Francisco, California, USA (J.Z. Metcalfe, P.C. Hopewell); Biomedical Research and Training Institute, Harare, Zimbabwe (S. Makumbirofa, B. Makamure, P. Mason); National Tuberculosis Control Program, Harare, Zimbabwe (C. Sandy); Harare City Health Department, Harare, Zimbabwe (W. Bara, S. Mungofa); University of Zimbabwe College of Health Sciences, Harare (P. Mason)

Main Article

Table

Characteristics of participants in study of MDR TB, Harare, Zimbabwe, 2011–2012*

Characteristic
MDR-TB, n = 25
Monoresistant TB, n = 14
Drug-sensitive TB, n = 90
Unconfirmed TB, n = 84
p value
Age, median (IQR) 34 (27–42) 35 (29–45) 37 (30–44) 39 (32–48) 0.67
Male, no. (%)
13 (52)
6 (43)
58 (64)
48 (57)
0.36
Retreatment category, no. (%)
Treatment failure 9 (36) 0 9 (10) 21 (25) <0.001
Late smear conversion 8 (32) 1 (7) 30 (33) 13 (16)
Default 0 (0.0) 2 (14) 13 (14) 7 (8)
Relapse 7 (28) 7 (50) 34 (38) 34 (41)
New
1 (4)
4 (29)
1 (1)
4 (5)

Sputum smear positivity, no. (%)
20 (80)
7 (50)
52 (53)
6 (7)
<0.001
HIV infection, no. (%) 18 (72) 13 (93) 57 (65) 69 (82) 0.02
Antiretroviral treatment, no. (%)
14 (78)
10 (77)
41 (72)
52 (75)
0.95
Time receiving TB treatment, median (IQR)
98 (4–175)
0 (0–3)
31 (2–103)
101 (5–186)
0.03
Prior treatment courses, no. (%)
None 8 (32) 5 (36) 30 (33) 21 (25) 0.52
1 12 (48) 7 (50) 40 (44) 40 (48)
≥2 5 (20) 2 (14) 20 (22) 22 (27)

*Retreatment classification was defined according to international standards (8); late smear conversion was defined as sputum AFB smear-positivity after month 3 but before month 5 of treatment. Monoresistant TB was defined as resistance to either isoniazid or rifampin, but not both. The denominator for antiretroviral treatment included persons with HIV infection. MDR TB, multidrug-resistant tuberculosis; IQR, interquartile range; AFB, acid-fast bacilli.

Main Article

References
  1. World Health Organization. Multidrug and extensively drug-resistant tuberculosis: 2010 global report on surveillance and response. Geneva: The Organization; 2010 [cited 2013 Aug 22]. http://whqlibdoc.who.int/publications/2010/9789241599191_eng.pdf
  2. World Health Organization. Global tuberculosis report 2012 [cited 2013 Jul 28]. http://www.who.int/tb/publications/global_report/en
  3. Corbett  EL, Bandason  T, Duong  T, Dauya  E, Makamure  B, Churchyard  GJ, Comparison of two active case-finding strategies for community-based diagnosis of symptomatic smear-positive tuberculosis and control of infectious tuberculosis in Harare, Zimbabwe (DETECTB): a cluster-randomised trial. Lancet. 2010;376:124453. DOIPubMed
  4. Zignol  M, van Gemert  W, Falzon  D, Sismanidis  C, Glaziou  P, Floyd  K, Surveillance of anti-tuberculosis drug resistance in the world: an updated analysis, 2007–2010. Bull World Health Organ. 2012;90:111–9D.
  5. Marais  BJ, Mlambo  CK, Rastogi  N, Zozio  T, Duse  AG, Victor  TC, Epidemic spread of multidrug-resistant tuberculosis in Johannesburg, South Africa. J Clin Microbiol. 2013;51:1818–25.
  6. Bateman  C. Zimbabwe meltdown fuelling MDRTB? S Afr Med J. 2008;98:156 .PubMed
  7. InRegional Office for Southern Africa. IOM detects possible TB problem amongst returning migrants at Plumtree Centre, Zimbabwe. A Bulletin of News, Information, and Analysis on Migration Health in Southern Africa. Issue 2, Nov 2009.
  8. World Health Organization. Treatment of tuberculosis: guidelines for national programmes, 4th edition. Geneva: the Organization; 2009.
  9. Makamure  B, Mhaka  J, Makumbirofa  S, Mutetwa  R, Mupfumi  L, Mason  P, Microscopic-observation drug-susceptibility assay for the diagnosis of drug-resistant tuberculosis in harare, zimbabwe. PLoS ONE. 2013;8:e55872 . DOIPubMed
  10. Mboma  SM, Houben  RM, Glynn  JR, Sichali  L, Drobniewski  F, Mpunga  J, Control of (multi)drug resistance and tuberculosis incidence over 23 years in the context of a well-supported tuberculosis programme in rural Malawi. PLoS ONE. 2013;8:e58192. DOIPubMed
  11. Samo Gudo  P, Cuna  Z, Coelho  E, Maungate  S, Borroni  E, Miotto  P, Is multidrug-resistant tuberculosis on the rise in Mozambique? Results of a national drug resistance survey. Eur Respir J. 2011;38:2224. DOIPubMed
  12. Sanchez-Padilla  E, Dlamini  T, Ascorra  A, Rusch-Gerdes  S, Tefera  ZD, Calain  P, High prevalence of multidrug-resistant tuberculosis, Swaziland, 2009–2010. Emerg Infect Dis. 2012;18:2937. DOIPubMed
  13. World Health Organization. Zimbabwe tuberculosis profile, 2012 [cited 2012 Oct 13]. https://extranet.who.int/sree/Reports?op=Replet&name=/WHO_HQ_Reports/G2/PROD/EXT/TBCountryProfile&ISO2=ZW&outtype=PDF
  14. Cohen  T, Colijn  C, Wright  A, Zignol  M, Pym  A, Murray  M. Challenges in estimating the total burden of drug-resistant tuberculosis. Am J Respir Crit Care Med. 2008;177:13026. DOIPubMed

Main Article

Page created: January 03, 2014
Page updated: January 03, 2014
Page reviewed: January 03, 2014
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external