Detection and management of drug-resistant tuberculosis in HIV-infected patients in lower-income countries

作者：Ballif M^*; Nhandu V; Wood R; Dusingize J C; Carter E J; Cortes C P; McGowan C C; Diero L; Graber C; Renner L; Hawerlander D; Kiertiburanakul S; Du Q T; Sterling T R; Egger M; Fenner L

来源：International Journal of Tuberculosis and Lung Disease, 2014, 18(11): 1327-1336.

DOI：10.5588/ijtld.14.0106

• MDR-TB
• ART programs
• Africa
• Asia
• Latin America

SETTING: Drug resistance threatens tuberculosis (TB) control, particularly among human immunodeficiency virus (HIV) infected persons. %26lt;br%26gt;OBJECTIVE: To describe practices in the prevention and management of drug-resistant TB under antiretroviral therapy (ART) programs in lower-income countries. %26lt;br%26gt;DESIGN: We used online questionnaires to collect program-level data on 47 ART programs in Southern Africa (n=14), East Africa (n=8), West Africa (n=7), Central Africa (n=5), Latin America (n=7) and the Asia-Pacific (n=6 programs) in 2012. Patient-level data were collected on 1002 adult TB patients seen at 40 of the participating ART programs. %26lt;br%26gt;RESULTS: Phenotypic drug susceptibility testing (DST) was available in 36 (77%) ART programs, but was only used for 22% of all TB patients. Molecular DST was available in 33 (70%) programs and was used in 23% of all TB patients. Twenty ART programs (43%) provided directly observed therapy (DOT) during the entire course of treatment, 16 (34%) during the intensive phase only, and 11(23%) did not follow DOT. Fourteen (30%) ART programs reported no access to second-line anti-tuberculosis regimens; 18 (38%) reported TB drug shortages. %26lt;br%26gt;CONCLUSIONS: Capacity to diagnose and treat drug-resistant TB was limited across ART programs in lower-income countries. DOT was not always implemented and drug supplies were regularly interrupted, which may contribute to the global emergence of drug resistance.

• 出版日期2014-11