First molecular-based anti-TB drug resistance survey in Eritrea

Berhane, Araia; Araia, Zenawi Zeramariam; Beyene, H N; Mebrahtu, Amanuel Hadgu; Suud, N N; Berhane, Y; Hailu, Derese; Kassahun, Ashebir; Auguet, Olga Tosas; Dean, Anna; Cabibbe, Andrea Maurizio; Cirillo, D

doi:10.5588/ijtld.20.0558

Cited by 15 publications

(12 citation statements)

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“…These figures are also lower than in neighbouring Indonesia, at 2.4% (95% CI 1.8-3.3%) among new cases and 13% (95% CI 9-18%) among previously treated cases, as well as the average for the WHO Southeast Asia Region, at 2.5% (95% CI 1.9-3.3%) among new cases and 14% (95% CI 7.7-21%) among previously treated cases [13]. Surveys in other small countries like Lao PDR [14] and Eritrea [15] were similarly low. One possible explanation for these lower level of rifampicin resistance in Timor-Leste may relate to the fact that rifampicin was only introduced into the four-month continuation phase of the first-line treatment regimen from the second quarter of 2015 (in line with the WHO-recommended regimen of 2HRZE + 4RH), which was much later than in neighbouring countries.…”

Section: Discussionmentioning

confidence: 99%

Experience on the first national anti-TB drug resistance survey (DRS) in Timor-Leste

Lopes

Kundu

Barreto

et al. 2022

glob health res policy

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Background A national drug resistance survey (DRS) was implemented for the first time in Timor-Leste (TL) in 2019. The primary objective of the survey was to assess the prevalence of drug resistance among new and previously treated pulmonary TB patients in the country. Methods This nation-wide cross-sectional survey was conducted in 2019 targeting all new and previously treated sputum smear-positive pulmonary TB patients. Sputum samples were submitted to the National TB Reference Laboratory for confirmation of TB and to determine resistance to rifampicin by Xpert MTB/RIF. Culture was performed on solid media, and culture isolates of confirmed TB cases were shipped to the WHO Supranational TB Reference Laboratory in Chennai, India for whole genome sequencing (WGS). Survey summary statistics, data cross-tabulations and analysis of potential risk factors of rifampicin-resistant TB (RR-TB) were conducted using R statistical software (version 3.5.2). Results A total of 953 sputum-smear positive patients were enrolled, of which 917 were confirmed as positive for TB by either Xpert MTB/RIF or culture. An electronic web-based system was used for entry and storage of the data. Rifampicin resistance was detected among 0.6% (95% CI 0.2–1.3) of new cases and 2.7% (95% CI 0.5- 8.2) of previously treated cases. WGS was conducted for validation purposes on 65 randomly selected isolates (29% of RR-TB (2/7) and 7% of RS-TB (63/910) by Xpert MTB/RIF or pDST). The original test results agreed with the WGS validation results for 62/64 isolates (97%). Conclusion The prevalence of RR-TB in Timor-Leste is relatively low compared to the estimated proportions of RR-TB in the WHO South-East Asia Region (2.5% [95% CI 1.9–3.3] among new cases and 14% [95% CI 7.7–21] among previously treated cases). The rapid sputum collection and transportation mechanism implemented in the survey demonstrates its feasibility in low resource settings and should be replicated for routinely transporting TB specimens from microscopy labs to GeneXpert sites. Establishment of in-country capacity for rapid molecular diagnostics for both first- and second-line DST is an immediate need for achieving universal drug susceptibility testing (DST) to guide appropriate patient management.

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Section: Discussionmentioning

confidence: 99%

Experience on the first national anti-TB drug resistance survey (DRS) in Timor-Leste

Lopes

Kundu

Barreto

et al. 2022

glob health res policy

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“…2 Moreover, RR/MDR-TB is recognized as an emerging threat to the control of tuberculosis with a prevalence of 2.0% among new and 7.5% among previously treated TB cases. 3 …”

Section: Introductionmentioning

confidence: 99%

Health-Related Quality of Life in Tuberculosis Patients in Eritrea: Comparison Among Drug-Susceptible and Rifampicin/Multidrug-Resistant Tuberculosis Patients

Araia¹,

Berhane²,

Mebrahtu³

et al. 2021

PROM

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Background Despite the negative impact of tuberculosis (TB) on patients’ quality of life, TB control programs focus on biological and clinical parameters to manage and monitor TB patients. In our setting, patients’ perception of their experience with TB and the impacts of TB on patients’ physical, mental, and social wellbeing remain unknown. Objective The objective of this study was to evaluate the health-related quality of life (HRQOL) among rifampicin/multidrug-resistant TB (RR/MDR-TB) in comparison to drug-susceptible TB (DS-TB) patients in Eritrea. Methods A cross-sectional study was conducted in RR/MDR-TB and DS-TB patients under treatment. Anonymized data collected using the WHOQOL-BREF questionnaire were analyzed using SPSS version 23. Frequency, mean and standard deviation were used to describe the data. Mean group score comparison and relationship between variables were assessed using t -test. Domain score was calculated with a mean score of items within each domain and scaled positively, a higher (increasing) score denoting a higher quality of life. Internal consistency was measured using Cronbach’s alpha and statistical significance was set at p < 0.05. Results A total of 92 patients (46 RR/MDR-TB and 46 DS-TB) participated in the study. Environmental (40.63 ± 10.72) and physical domains (61.80 ±17.18) were the two most affected domains in RR/MDR-TB and DS-TB patients, respectively. The psychological domain was the least affected domain in RR/MDR-TB (48.28 ± 20.83) and DS-TB patients (76.63 ±15.32). RR/MDR-TB patients had statistically lower mean scores in all domains than DS-TB patients. Conclusion HRQOL was impaired in both groups, but RR/MDR-TB patients had a worse health-related quality of life.

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“…The DNA isolation described in this study was performed in a tuberculosis research laboratory in Eswatini, proving that it can be implemented in other high-burden settings. Likewise, the Deeplex® Myc-TB assay streamlines sequencing requirements and has now been implemented in national drug resistance surveys in sub-Saharan Africa [ 21 , 31 ], suggesting that this approach may also be suitable for high-burden settings. Indeed, implementation of tNGS through the SeqMDRTB_NET network project ( https://ghpp.de/de/projekte/seqmdrtb-net/ ) in multiple Sub-Saharan countries, including Eswatini, is currently underway.…”

Section: Discussionmentioning

confidence: 99%

Rapid molecular diagnostics of tuberculosis resistance by targeted stool sequencing

et al. 2022

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Background Stool is an important diagnostic specimen for tuberculosis in populations who struggle to provide sputum, such as children or people living with HIV. However, the culture of Mycobacterium tuberculosis (M. tuberculosis) complex strains from stool perform poorly. This limits the opportunity for phenotypic drug resistance testing with this specimen. Therefore, reliable molecular methods are urgently needed for comprehensive drug resistance testing on stool specimens. Methods We evaluated the performance of targeted next-generation sequencing (tNGS, Deeplex® Myc-TB) for the detection of mutations associated with M. tuberculosis complex drug resistance on DNA isolated from stool specimens provided by participants from a prospective cohort of patients treated for tuberculosis in Eswatini (n = 66; 56 with and 10 participants without M. tuberculosis complex DNA detected in stool by real-time quantitative PCR), and an independent German validation cohort of participants with culture-confirmed tuberculosis (n = 21). Results The tNGS assay detected M. tuberculosis complex DNA in 38 of 56 (68%) samples; for 28 of 38 (74%) samples, a full M. tuberculosis complex drug resistance prediction report was obtained. There was a high degree of concordance with sputum phenotypic drug susceptibility results (κ = 0.82). The ability to predict resistance was concentration-dependent and successful in 7/10 (70%), 18/25 (72%), and 3/21 (14%) of samples with stool PCR concentration thresholds of > 100 femtogram per microliter (fg/μl), 1 to 100 fg/μl, and < 1 fg/μl, respectively (p = 0.0004). The German cohort confirmed these results and demonstrated a similarly high concordance between stool tNGS and sputum phenotypic drug susceptibility results (κ = 0.84). Conclusions tNGS can identify drug resistance from stool provided by tuberculosis patients. This affords the opportunity to obtain critical diagnostic information for tuberculosis patients who struggle to provide respiratory specimens.

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First molecular-based anti-TB drug resistance survey in Eritrea

Cited by 15 publications

References 0 publications

Experience on the first national anti-TB drug resistance survey (DRS) in Timor-Leste

Experience on the first national anti-TB drug resistance survey (DRS) in Timor-Leste

Health-Related Quality of Life in Tuberculosis Patients in Eritrea: Comparison Among Drug-Susceptible and Rifampicin/Multidrug-Resistant Tuberculosis Patients

Rapid molecular diagnostics of tuberculosis resistance by targeted stool sequencing

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