Tuberculosis Treatment Outcome and Drug Resistance in Lambaréné, Gabon: A Prospective Cohort Study

Abstract

Despite overall global progress in tuberculosis (TB) control, TB remains one of the deadliest communicable diseases. This study prospectively assessed TB epidemiology in Lambaréné, Gabon, a Central African country ranking 10th in terms of TB incidence rate in the 2014 World Health Organization TB report. In Lambaréné, between 2012 and 2014, 201 adult and pediatric TB patients were enrolled and followed up; 66% had bacteriologically confirmed TB and 95% had pulmonary TB. The human immunodeficiency virus (HIV) coinfection rate was 42% in adults and 16% in children. Mycobacterium tuberculosis and Mycobacterium africanum were identified in 82% and 16% of 108 culture-confirmed TB cases, respectively. Isoniazid (INH) and streptomycin yielded the highest resistance rates (13% and 12%, respectively). The multidrug resistant TB (MDR-TB) rate was 4/91 (4%) and 4/13 (31%) in new and retreatment TB cases, respectively. Treatment success was achieved in 53% of patients. In TB/HIV coinfected patients, mortality rate was 25%. In this setting, TB epidemiology is characterized by a high rate of TB/HIV coinfection and low treatment success rates. MDR-TB is a major public health concern; the need to step-up in-country diagnostic capacity for culture and drug susceptibility testing as well as access to second-line TB drugs urgently requires action.

© The American Society of Tropical Medicine and Hygiene.

Figures

Figure 1.

Survival analysis of tuberculosis (TB) patients in Lambaréné 2012–2013 (survival defined as availability of any information on the patient being alive 5 months after treatment initiation or later). A = Human immunodeficiency virus (HIV)–uninfected patients excluding multidrug-resistant TB (MDR-TB) (N = 96, deaths N = 0); B = all patients excluding MDR-TB (N = 169, deaths N = 17); C = all patients (N = 174, deaths N = 18); D = HIV-infected patients excluding MDR-TB (N = 59, deaths N = 17). Twenty-seven patients were excluded for survival analysis because the dates of death/loss of follow-up/study end were not available.