Free Content Low levels of drug resistance amidst rapidly increasing tuberculosis and human immunodeficiency virus co-epidemics in Botswana

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SETTING: Botswana, southern Africa, where the tuberculosis (TB) case rate increased by 120% from 1989 to 1996 in spite of a decade of implementation of the directly observed therapy, short-course (DOTS) strategy.

OBJECTIVE: To determine prevalence of and risk factors for drug-resistant tuberculosis in an epidemic setting.

DESIGN: Systematic national random survey of newly diagnosed pulmonary TB and all patients with TB requiring retreatment during 1995–1996. Interviews were conducted, human immunodeficiency virus (HIV) testing was offered, and drug susceptibility testing was performed for isoniazid, rifampicin, streptomycin and ethambutol.

RESULTS: Resistance to at least one drug was identified in 16 (3.7%) new cases and 18 (14.9%) retreatment cases. One (0.2%) new and seven (5.8%) retreatment cases had resistance to at least both isoniazid and rifampicin (multidrug-resistant TB). Retreatment cases with multidrug-resistant TB were significantly more likely to have worked in the mines in South Africa than were cases with fully susceptible isolates (6/7 [85.7%] versus 32/103 [31.1%], odds ratio 13.3, 95% confidence interval 1.5–311.0, P = 0.007). Of 240 patients tested for HIV, 117 (48.8%) were positive; prevalence was similar among new and retreatment cases, and was not a risk factor for drug resistance in either group.

CONCLUSION: During the HIV and TB co-epidemics in sub-Saharan Africa, DOTS may help to control drug-resistant TB. However, the TB case rate can be expected to continue to climb in spite of the implementation of the DOTS strategy.

Keywords: Africa, Botswana; directly-observed therapy; drug resistance; human immunodeficiency virus; survey; tuberculosis

Document Type: Regular Paper

Affiliations: 1: BOTUSA TB Project, Gaborone, Botswana, and Division of TB Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 2: Ministry of Health, Gaborone, Botswana 3: South African Institute for Medical Research, Johannesburg, South Africa

Publication date: January 1, 1999

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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