Prevalence of drug resistant TB among outpatients at an HIV/TB clinic in Lilongwe, Malawi

Trans R Soc Trop Med Hyg. 2015 Dec;109(12):763-8. doi: 10.1093/trstmh/trv092.

Abstract

Background: We sought to determine the prevalence of drug resistant TB among outpatients initiating TB treatment in Lilongwe, Malawi.

Methods: This was a prospective cohort study of patients 18 years and older initiating TB treatment at Martin Preuss Centre, the primary integrated HIV/TB clinic in Lilongwe, Malawi, from April 2011 to July 2012. Procedures included questionnaires, physical exam, chest x-ray, full blood count and sputum collection. Sputum samples underwent acid-fast bacilli (AFB) smear testing and culture by Lowenstein-Jensen (LJ) and liquid Mycobacteria Growth Indicator Tube (MGIT) methods. Drug sensitivity was investigated using the Hain GenoType MTBDRplus line probe assay.

Results: Of the 702 patients, 219 (31.2%) were female and 653 (93.0%) were presenting for first-time TB treatment. HIV co-infection was present in 420 (59.8%) cases, with 137 (32.6%) of those patients receiving antiretroviral therapy at presentation. TB was culture-confirmed in 375 (53.4%) patients, 349 of which were first time treatment and 26 retreatment. Ten cases of isoniazid-resistant TB (2.9% of culture confirmed cases of newly treated TB), one of rifampin-resistant TB (0.3% culture confirmed cases of newly treated TB) and one of multi-drug resistant TB (MDR-TB) (3.8% of culture confirmed cases of retreatment TB) were detected.

Conclusions: MDR-TB prevalence is low among outpatients initiating TB treatment in Lilongwe.

Keywords: Africa South of the Sahara; Epidemiology; Isoniazid; Multi-drug resistant; Rifampin; Tuberculosis.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antitubercular Agents / pharmacology
  • Antitubercular Agents / therapeutic use
  • Coinfection / epidemiology
  • Female
  • HIV Infections / epidemiology
  • Humans
  • Isoniazid / pharmacology
  • Isoniazid / therapeutic use
  • Malawi / epidemiology
  • Male
  • Middle Aged
  • Mycobacterium tuberculosis / drug effects
  • Mycobacterium tuberculosis / isolation & purification
  • Prevalence
  • Prospective Studies
  • Rifampin / pharmacology
  • Rifampin / therapeutic use
  • Sputum / microbiology
  • Tuberculosis, Multidrug-Resistant / drug therapy
  • Tuberculosis, Multidrug-Resistant / epidemiology*
  • Young Adult

Substances

  • Antitubercular Agents
  • Isoniazid
  • Rifampin