Anti-tuberculosis drug resistance among new and previously treated sputum smear-positive tuberculosis patients in Uganda: results of the first national survey

Deus Lukoye, Francis Adatu, Kenneth Musisi, George William Kasule, Willy Were, Rosemary Odeke, Julius Namonyo Kalamya, Ann Awor, Anand Date, Moses L Joloba, Deus Lukoye, Francis Adatu, Kenneth Musisi, George William Kasule, Willy Were, Rosemary Odeke, Julius Namonyo Kalamya, Ann Awor, Anand Date, Moses L Joloba

Abstract

Background: Multidrug resistant and extensively drug resistant tuberculosis (TB) have become major threats to control of tuberculosis globally. The rates of anti-TB drug resistance in Uganda are not known. We conducted a national drug resistance survey to investigate the levels and patterns of resistance to first and second line anti-TB drugs among new and previously treated sputum smear-positive TB cases.

Methods: Sputum samples were collected from a nationally representative sample of new and previously treated sputum smear-positive TB patients registered at TB diagnostic centers during December 2009 to February 2011 using a weighted cluster sampling method. Culture and drug susceptibility testing was performed at the national TB reference laboratory.

Results: A total of 1537 patients (1397 new and 140 previously treated) were enrolled in the survey from 44 health facilities. HIV test result and complete drug susceptibility testing (DST) results were available for 1524 (96.8%) and 1325 (85.9%) patients, respectively. Of the 1209 isolates from new cases, resistance to any anti-TB drug was 10.3%, 5% were resistant to isoniazid, 1.9% to rifampicin, and 1.4% were multi drug resistant. Among the 116 isolates from previously treated cases, the prevalence of resistance was 25.9%, 23.3%, 12.1% and 12.1% respectively. Of the 1524 patients who had HIV testing 469 (30.7%) tested positive. There was no association between anti-TB drug resistance (including MDR) and HIV infection.

Conclusion: The prevalence of anti-TB drug resistance among new patients in Uganda is low relative to WHO estimates. The higher levels of MDR-TB (12.1%) and resistance to any drug (25.3%) among previously treated patients raises concerns about the quality of directly observed therapy (DOT) and adherence to treatment. This calls for strengthening existing TB control measures, especially DOT, routine DST among the previously treated TB patients or periodic drug resistance surveys, to prevent and monitor development and transmission of drug resistant TB.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Map showing Health care facilties…
Figure 1. Map showing Health care facilties which participated in the National anti-TB drug resistance survey December 2009–February 2011.
Figure 2. Flow Chart of patient enrollment…
Figure 2. Flow Chart of patient enrollment in the National Anti-TB drug resistance survey in Uganda; December 2009–February 2011.
Figure legend: **NTM = Non Tuberculous Mycobacteria.

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