Estimating the global burden of multidrug-resistant tuberculosis among prevalent cases of tuberculosis
METHODS: Using World Health Organization data reported by 217 countries/territories in 2014, we calculated the MDR-TB burden among prevalent TB cases and compared these with estimates among incident and notified TB patients. We also compared treatment coverage across estimates.
RESULTS: Among prevalent TB patients worldwide in 2014, we estimate that 555 545 (95% credible bounds 499 340–617 391) MDR-TB cases occurred. This is 85% more than the 300 000 estimated among notified cases, and 16% more than the 480 000 among incident cases. Only 20% of MDR-TB cases among prevalent—compared to 37% of MDR-TB among notified—TB patients had access to MDR-TB treatment. Applying prior estimates, only 10% of MDR-TB cases will have successful outcomes.
CONCLUSION: Estimates based on likely-to-be-diagnosed cases of MDR-TB overlook a significant proportion of morbidity, mortality, and transmission that occur in undiagnosed, untreated, prevalent TB patients. Even though it may still likely underestimate the true disease burden, MDR-TB among patients with prevalent TB represents a closer approximation of disease burden than currently reported indicators. Progress toward elimination or control depends on policies guided by a more complete representation of the disease burden.
Document Type: Research Article
Affiliations: 1: Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands 2: Division of Global Health Equity, Brigham and Women's Hospital, Boston, Department of Biostatistics, Boston University School of Public Health, Boston, USA 3: Department of Global Health and Social Medicine, Harvard Medical School, Boston, Bouvé College of Health Sciences, Northeastern University, Boston, USA 4: Division of Global Health Equity, Brigham and Women's Hospital, Boston, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Partners In Health, Boston, Massachusetts, USA
Publication date: 2017-01-01
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