Multidrug- and isoniazid-resistant tuberculosis in three high HIV burden African regions.

SETTING: Despite major progress in the surveillance of drug-resistant tuberculosis (TB), data are lacking for many low-resource countries. World Health Organization estimates of multidrug-resistant TB (MDR-TB) rates in Africa are low, and based on very limited data from the African continent.

OBJECTIVE: To measure MDR-TB prevalence in sub-Saharan African regions with a high prevalence of human immunodeficiency virus (HIV).

METHOD: We conducted three anti-tuberculosis drug resistance surveys in sub-Saharan African regions with high HIV-TB coinfection prevalence: Homa Bay (Kenya), Chiradzulu (Malawi) and West Nile region (Uganda).

RESULTS: The prevalence of MDR-TB in new patients was found to be low in the three regions: 1.4% (95%CI 0.2-2.6) in Homa Bay, 2.0% (95%CI 0.4-3.6) in Chiradzulu and 0.6% (95%CI 0.0-1.5) in the West Nile region. We found no significant association between MDR-TB and HIV infection. Nonetheless, ≥ 10% of the new cases surveyed were resistant to isoniazid (INH).

CONCLUSION: The relatively high rate of resistance to INH highlights the need for rapid detection of INH resistance in addition to rifampicin (RMP) resistance, to allow rapid modification of treatment to avoid the acquisition of RMP resistance. Drug resistance should be monitored periodically.