High Prevalence of Rifampicin Resistance Associated with Rural Residence and Very Low Bacillary Load among TB/HIV-Coinfected Patients at the National Tuberculosis Treatment Center in Uganda

Baluku, Joseph Baruch; Mugabe, Pallen; Mulwana, Rose; Nassozi, Sylvia; Katuramu, Richard; Worodria, William

doi:10.1155/2020/2508283

Cited by 11 publications

(6 citation statements)

References 40 publications

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“…Studies have shown that previous TB drug exposure, especially in inadequate or inappropriate doses, can result in an increased risk of developing mono-drug or multidrugresistant tuberculosis [25][26][27][28]. The findings of this study of higher prevalence of MTB drug resistance among previously treated patients is consistent with findings of other Ugandan studies [25,29,30] and other neighbouring countries [4,31,32]. These high levels of drug resistance among previously treated patients raise concerns about TB treatment compliance and the successful application of drug resistance preventive measures such as directly observed…”

Section: Discussionsupporting

confidence: 87%

Rifampicin and isoniazid drug resistance among patients diagnosed with pulmonary tuberculosis in southwestern Uganda

et al. 2021

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Multidrug-resistant tuberculosis (MDR-TB) has become a major threat to the control of tuberculosis globally. Uganda is among the countries with a relatively high prevalence of tuberculosis despite significant control efforts. In this study, the drug resistance of Mycobacterium tuberculosis to rifampicin (RIF) and isoniazid (INH) was investigated among patients diagnosed with pulmonary tuberculosis in Southwestern Uganda. A total of 283 sputum samples (266 from newly diagnosed and 17 from previously treated patients), collected between May 2018 and April 2019 at four different TB diagnostic centres, were assessed for RIF and INH resistance using high-resolution melt curve analysis. The overall prevalence of monoresistance to INH and RIF was 8.5% and 11% respectively, while the prevalence of MDR-TB was 6.7%. Bivariate analysis showed that patients aged 25 to 44 years were at a higher risk of developing MDR-TB (cOR 0.253). Furthermore, among the newly diagnosed patients, the prevalence of monoresistance to INH, RIF and MDR-TB was 8.6%, 10.2% and 6.4% respectively; while among the previously treated cases, these prevalence rates were 5.9%, 23.5% and 11.8%. These rates are higher than those reported previously indicating a rise in MTB drug resistance and may call for measures used to prevent a further rise in drug resistance. There is also a need to conduct frequent drug resistance surveys, to monitor and curtail the development and spread of drug-resistant TB.

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Section: Discussionsupporting

confidence: 87%

Rifampicin and isoniazid drug resistance among patients diagnosed with pulmonary tuberculosis in southwestern Uganda

et al. 2021

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“…HIV positive status is statistically significantly associated with MDR - TB, the study findings indicated that 26.9% of HIV positives had MDR-TB. This is agreeing with a Ugandan study 16 , which found out that the prevalence of MDR-TB was 32.4% among HIV/TB co-infected patients. Another study 14 reported that 40% - 70% of HIV patients in Ethiopia are co-infected with MDR-TB.…”

Section: Discussionsupporting

confidence: 92%

Assessment of risk factors associated with multi-drug resistant tuberculosis (MDR-TB) in Gulu regional referral hospital

Omona,

Mucha Opiyo

2023

Afr H. Sci.

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Background: Multi-drug resistant tuberculosis (MDR-TB) is increasingly recognized as emerging infectious disease of publichealth concern. Globally, 206030 people were diagnosed with MDR-TB in 2019, representing a 10% increase from 186883peoplewho had it in 2018. In Uganda, the prevalence of MDR among new TB cases is 4.4% and 17.7% among previously treatedTB cases. Aim: To determine the risk factors associated with MDR-TB among tuberculosis patients in Gulu regional referral hospital. Material and Methods: A cross-sectional analytical study using both quantitative and qualitative methods of data collectionand analysis was used. Data was collected from 384 TB patients using data extraction form and 6 Key informant interviewsconducted. Analysis using Pearson chi-square test was run. Results: HIV positive patients were 2.6 times more likely to be infected with MDR-TB than HIV negative patients [AOR=2.6:95% CI 1.34– 5.85: P=0.006]. Previously treated TB patients were 2.8 times more likely to be infected with MDR-TB than newlydiagnosed TB patients [AOR=2.8: 95% CI 1.33– 5.85: P=0.006]. Defaulting TB patients were 3.1 times more likely to be infectedwith MDR-TB than the non-defaulting TB patients [AOR=3.1] Conclusion: There is high prevalence of drug resistance among patients attending TB treatment at the facility. Keywords: MDR-TB; tuberculosis; HIV; Gulu Regional Referral Hospital.

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“…Identifying gender differences can guide implementation of gender-specific interventions to improve DRTB treatment outcomes. Uganda is a TB/HIV high burdened country, and 52–62% of patients with DRTB are co-infected with HIV [ 18 , 19 ]. In this study, we compared socio-demographic and clinical characteristics and treatment outcomes of DRTB/HIV co-infected men and women in Uganda, drawn from a large countrywide retrospective cohort [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Gender differences among patients with drug resistant tuberculosis and HIV co-infection in Uganda: a countrywide retrospective cohort study

et al. 2021

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Background Gender differences among patients with drug resistant tuberculosis (DRTB) and HIV co-infection could affect treatment outcomes. We compared characteristics and treatment outcomes of DRTB/HIV co-infected men and women in Uganda. Methods We conducted a retrospective chart review of patients with DRTB from 16 treatment sites in Uganda. Eligible patients were aged ≥ 18 years, had confirmed DRTB, HIV co-infection and a treatment outcome registered between 2013 and 2019. We compared socio-demographic and clinical characteristics and tuberculosis treatment outcomes between men and women. Potential predictors of mortality were determined by cox proportional hazard regression analysis that controlled for gender. Statistical significance was set at p < 0.05. Results Of 666 DRTB/HIV co-infected patients, 401 (60.2%) were men. The median (IQR) age of men and women was 37.0 (13.0) and 34.0 (13.0) years respectively (p < 0.001). Men were significantly more likely to be on tenofovir-based antiretroviral therapy (ART), high-dose isoniazid-containing DRTB regimen and to have history of cigarette or alcohol use. They were also more likely to have multi-drug resistant TB, isoniazid and streptomycin resistance and had higher creatinine, aspartate and gamma-glutamyl aminotransferase and total bilirubin levels. Conversely, women were more likely to be unemployed, unmarried, receive treatment from the national referral hospital and to have anemia, a capreomycin-containing DRTB regimen and zidovudine-based ART. Treatment success was observed among 437 (65.6%) and did not differ between the genders. However, mortality was higher among men than women (25.7% vs. 18.5%, p = 0.030) and men had a shorter mean (standard error) survival time (16.8 (0.42) vs. 19.0 (0.46) months), Log Rank test (p = 0.046). Predictors of mortality, after adjusting for gender, were cigarette smoking (aHR = 4.87, 95% CI 1.28–18.58, p = 0.020), an increase in alanine aminotransferase levels (aHR = 1.05, 95% CI 1.02–1.07, p < 0.001), and history of ART default (aHR = 3.86, 95% CI 1.31–11.37, p = 0.014) while a higher baseline CD4 count was associated with lower mortality (aHR = 0.94, 95% CI 0.89–0.99, p = 0.013 for every 10 cells/mm3 increment). Conclusion Mortality was higher among men than women with DRTB/HIV co-infection which could be explained by several sociodemographic and clinical differences.

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High Prevalence of Rifampicin Resistance Associated with Rural Residence and Very Low Bacillary Load among TB/HIV-Coinfected Patients at the National Tuberculosis Treatment Center in Uganda

Cited by 11 publications

References 40 publications

Rifampicin and isoniazid drug resistance among patients diagnosed with pulmonary tuberculosis in southwestern Uganda

Rifampicin and isoniazid drug resistance among patients diagnosed with pulmonary tuberculosis in southwestern Uganda

Assessment of risk factors associated with multi-drug resistant tuberculosis (MDR-TB) in Gulu regional referral hospital

Gender differences among patients with drug resistant tuberculosis and HIV co-infection in Uganda: a countrywide retrospective cohort study

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