Second nationwide anti-tuberculosis drug resistance survey in Namibia

• Published in: The international journal of tuberculosis and lung disease Vol. 23; no. 7; pp. 858 - 864
• Main Authors: Ruswa, N., Mavhunga, F., Roscoe, J. C., Beukes, A., Shipiki, E., van Gorkom, J., Sawadogo, S., Agolory, S., Menzies, H., Tiruneh, D., Makumbi, B., Bayer, B., Zezai, A., Campbell, P., Alexander, H., Kalisvaart, N., Forster, N.
• Format: Journal Article
• Language: English
• Published: France International Union Against Tuberculosis and Lung Disease 01-07-2019; International Union against Tuberculosis and Lung Disease (IUATLD)
• Subjects: Adolescent; Adult; Aged; Antibiotics, Antitubercular - pharmacology; Antibiotics, Antitubercular - therapeutic use; Child; Child, Preschool; Comorbidity; Culture; Demographics; Drs; Drug resistance; Ethambutol; Female; HIV; HIV Infections; Human immunodeficiency virus; Humans; Infant; Infant, Newborn; Isoniazid; Male; Mass Screening; Mdr-Tb; Microbial Sensitivity Tests; Microscopy; Middle Aged; Multidrug resistance; Mycobacterium tuberculosis - drug effects; Mycobacterium tuberculosis - isolation & purification; Namibia - epidemiology; Polls & surveys; Prevalence; Rifampin; Sexually transmitted diseases; Sputum; STD; Streptomycin; Surveillance; Surveys and Questionnaires; Tuberculosis; Tuberculosis, Multidrug-Resistant - drug therapy; Tuberculosis, Multidrug-Resistant - epidemiology; Tuberculosis, Multidrug-Resistant - microbiology; Tuberculosis, Multidrug-Resistant - prevention & control; Tuberculosis, Pulmonary - drug therapy; Tuberculosis, Pulmonary - epidemiology; Tuberculosis, Pulmonary - microbiology; Tuberculosis, Pulmonary - prevention & control; Young Adult; Namibia
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.18.0526

SETTING: Namibia ranks among the 30 high TB burden countries worldwide. Here, we report results of the second nationwide anti-TB drug resistance survey.OBJECTIVE: To assess the prevalence and trends of multidrug-resistant TB (MDR-TB) in Namibia.METHODS:
From 2014 to 2015, patients with presumptive TB in all regions of Namibia had sputum subjected to mycobacterial culture and phenotypic drug susceptibility testing (DST) for rifampicin, isoniazid, ethambutol and streptomycin if positive on smear microscopy and/or Xpert MTB/RIF.RESULTS:
Of the 4124 eligible for culture, 3279 (79.5%) had Mycobacterium tuberculosis isolated. 3126 (95%) had a first-line DST completed (2392 new patients, 699 previously treated patients, 35 with unknown treatment history). MDR-TB was detected in 4.5% (95%CI 3.7-5.4) of new patients,
and 7.9% (95%CI 6.0-10.1) of individuals treated previously. MDR-TB was significantly associated with previous treatment (OR 1.8, 95%CI 1.3-2.5) but not with HIV infection, sex, age or other demographic factors. Prior treatment failure demonstrated the strongest association with
MDR-TB (OR 17.6, 95%CI 5.3-58.7).CONCLUSION: The prevalence of MDR-TB among new TB patients in Namibia is high and, compared with the first drug resistance survey, has decreased significantly among those treated previously. Namibia should implement routine screening of drug
resistance among all TB patients.