Multidrug-resistant tuberculosis in Burkina Faso from 2006 to 2017: Results of national surveys

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Abstract

Setting: A survey of the prevalence of drug-resistant tuberculosis (DR-TB) in new and previously treated patients (PTPs) was performed in Burkina Faso from 2016 to 2017.

Design: In this cross-sectional survey, a structured questionnaire was administered to eligible smear-positive patients in all 86 diagnostic and treatment centers of the country to collect their socio-demographic characteristics and medical histories. Their sputa were tested using the Mycobacterium tuberculosis/rifampicin (MTB/RIF) Xpert assay. Those which were found to be positive for TB and rifampicin-resistant were also tested with GenoType MTBDRplus2.0 and MTBDRsl2.0. Univariate and multivariate logistic regressions were performed to determine risk factors associated with rifampicin resistance.

Results: Of the 1140 smear-positive patients enrolled, 995 new and 145 PTPs were positive for MTB complex by Xpert. Of these, 2.0% (20/995, 95% confidence interval (CI): 1.1–2.9) of the new cases and 14.5% (95% CI: 14.2–20.2) of the PTPs were resistant to rifampicin; 83% of them has multidrug-resistant tuberculosis (MDR-TB). None were pre-extensively drug-resistant TB (pre-XDR-TB) or XDR-TB. Only the previous treatment was significantly associated with rifampicin resistance, p < 0.0001.

Conclusion: Similar to global trends, rifampicin resistance was significantly higher in patients with prior TB treatment (14.5%) than in naïve patients (2.0%). These percentages are slightly below the global averages, but nonetheless suggest the need for continued vigilance. Extending the use of Xpert testing should strengthen the surveillance of DR-TB in Burkina Faso.

Most cited references 24

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The social determinants of tuberculosis: from evidence to action.

James R Hargreaves, Delia Boccia, Carlton A Evans … (2011)

Growing consensus indicates that progress in tuberculosis control in the low- and middle-income world will require not only investment in strengthening tuberculosis control programs, diagnostics, and treatment but also action on the social determinants of tuberculosis. However, practical ideas for action are scarcer than is notional support for this idea. We developed a framework based on the recent World Health Organization Commission on Social Determinants of Health and on current understanding of the social determinants of tuberculosis. Interventions from outside the health sector-specifically, in social protection and urban planning-have the potential to strengthen tuberculosis control.

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World Health Organization treatment guidelines for drug-resistant tuberculosis, 2016 update

Dennis Falzon, Holger Schünemann, Elizabeth Harausz … (2017)

Antimicrobial resistance is a major global concern. Tuberculosis (TB) strains resistant to rifampicin and other TB medicines challenge patient survival and public health. The World Health Organization (WHO) has published treatment guidelines for drug-resistant TB since 1997 and last updated them in 2016 based on reviews of aggregated and individual patient data from published and unpublished studies. An international expert panel formulated recommendations following the GRADE approach. The new WHO guidelines recommend a standardised 9–12 months shorter treatment regimen as first choice in patients with multidrug- or rifampicin-resistant TB (MDR/RR-TB) strains not resistant to fluoroquinolones or second-line injectable agents; resistance to these two classes of core second-line medicines is rapidly detectable with molecular diagnostics also approved by WHO in 2016. The composition of longer regimens for patients ineligible for the shorter regimen was modified. A first-ever meta-analysis of individual paediatric patient data allowed treatment recommendations for childhood MDR/RR-TB to be made. Delamanid is now also recommended in patients aged 6–17 years. Partial lung resection is a recommended option in MDR/RR-TB care. The 2016 revision highlighted the continued shortage of high-quality evidence and implementation research, and reiterated the need for clinical trials and best-practice studies to improve MDR/RR-TB patient treatment outcomes and strengthen policy.

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Is HIV Infection a Risk Factor for Multi-Drug Resistant Tuberculosis? A Systematic Review

Sujit Suchindran, Emily S Brouwer, Annelies van Rie (2009)

Background Tuberculosis (TB) is an important cause of human suffering and death. Human immunodeficiency virus (HIV), multi-drug resistant TB (MDR-TB), and extensive drug resistant tuberculosis (XDR-TB) have emerged as threats to TB control. The association between MDR-TB and HIV infection has not yet been fully investigated. We conducted a systematic review and meta-analysis to summarize the evidence on the association between HIV infection and MDR-TB. Methods and Results Original studies providing Mycobacterium tuberculosis resistance data stratified by HIV status were identified using MEDLINE and ISI Web of Science. Crude MDR-TB prevalence ratios were calculated and analyzed by type of TB (primary or acquired), region and study period. Heterogeneity across studies was assessed, and pooled prevalence ratios were generated if appropriate. No clear association was found between MDR-TB and HIV infection across time and geographic locations. MDR-TB prevalence ratios in the 32 eligible studies, comparing MDR-TB prevalence by HIV status, ranged from 0.21 to 41.45. Assessment by geographical region or study period did not reveal noticeable patterns. The summary prevalence ratios for acquired and primary MDR-TB were 1.17 (95% CI 0.86, 1.6) and 2.72 (95% CI 2.03, 3.66), respectively. Studies eligible for review were few considering the size of the epidemics. Most studies were not adjusted for confounders and the heterogeneity across studies precluded the calculation of a meaningful overall summary measure. Conclusions We could not demonstrate an overall association between MDR-TB and HIV or acquired MDR-TB and HIV, but our results suggest that HIV infection is associated with primary MDR-TB. Future well-designed studies and surveillance in all regions of the world are needed to better clarify the relationship between HIV infection and MDR-TB.

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Author and article information

Journal

Journal ID (publisher-id): 1886

Title: European Journal of Microbiology and Immunology

Abbreviated Title: EuJMI

Publisher: Akadémiai Kiadó

ISSN (Electronic): 2062-8633

Publication date (Print): March 2019

Volume: 9

Issue: 1

Pages: 23-28

Affiliations

[ ¹ ]Programme National de Lutte contre la Tuberculose, Ministère de la Santé , Ouagadougou, Burkina Faso

[ ² ] Université Ouaga-I Pr Joseph Ki-Zerbo , Unité de Formation en Sciences de la Santé, Ouagadougou, Burkina Faso

[ ³ ] CHU Yalgado Ouédraogo , Département de Médecine, Services de Pneumologie, Ouagadougou, Burkina Faso

[ ⁴ ] Centre National de Lutte Antituberculeuse , Ministère de la Santé, Ouagadougou, Burkina Faso

[ ⁵ ]Direction de la Protection de la Santé et de la Population, Ministère de la Santé , Ouagadougou, Burkina Faso

[ ⁶ ] CHU Yalgado Ouédraogo , Département des laboratoires, Service de Bactériologie-Virologie Ouagadougou, Burkina Faso

Author notes

[*]

Author for correspondence: 09 PB 1188 Ouagadougou, Burkina Faso, West Africa; diandesouba@ 123456hotmail.com ; tel: +22670118360; fax: +226 36 09 51.

Article

DOI: 10.1556/1886.2018.00029

PMC ID: 6444799

PubMed ID: 30967972

SO-VID: 5c0c3939-2169-46a2-a793-4b0f399a820d

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes - if any - are indicated.

History

Date received : 7 November 2018

Date accepted : 7 January 2019

Date: 6 February 2019

Page count

Pages: 6

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