High time to use rapid tests to detect multidrug resistance in sputum smear-negative tuberculosis in Belarus

Abstract

Eastern Europe is facing an epidemic of multidrug-resistant tuberculosis (MDR-TB). 1,2 Belarus is one of the 27 high MDR-TB burden countries designated by the World Health Organization (WHO). A countrywide survey conducted in 2011 in Belarus revealed a prevalence of MDR-TB of 32% among new and 76% among previously treated TB cases, the highest documented rates worldwide. 3,4 However, these levels were found among sputum smear-positive pulmonary TB (SP-PTB) patients. The levels of MDR-TB among smear-negative pulmonary TB (SN-PTB) patients are unknown, and this group accounts for 63% of all notified new pulmonary TB cases in Belarus. 1 Countries in the WHO European region endorsed the 'Consolidated Action Plan, 2011Plan, -2015, with the aim of detecting 85% of estimated MDR-TB cases and successfully treating at least 75% of these by 2015. 5 Achieving these objectives will not be possible without appropriate management of MDR-TB among SN-PTB.In Belarus, all TB patients have universal access to culture and drug susceptibility testing (CDST). In 2012, at the start of the countrywide roll-out of rapid molecular diagnostics (such as Xpert® MTB/RIF [Cepheid, Inc, Sunnyvale, CA, USA] and line probe assays), national policy prioritised their use for smear-positive TB patients, while SN-PTB patients were investigated using conventional methods, often delaying the diagnosis of MDR-TB by 2-4 months. While awaiting the results, SN-PTB patients were initiated on a first-line drug regimen, which was obviously inadequate if they harboured MDR-TB bacilli. With the increasing availability of rapid molecular diagnostics, the country is currently aiming at universal coverage of all presumptive TB cases with molecular testing. Despite the national policy, SN-PTB patients do not receive the same priority as smear-positive TB patients, as they are traditionally perceived to be less infectious and clinically less severe. Currently, there is no published information from Belarus or similar settings in Eastern Europe on the proportion of SN-PTB patients with MDR-TB. Such information provides the evidence required to decide on and justify the use of rapid molecular diagnostics for all SN-PTB patients.In this countrywide audit in Belarus, we therefore aimed to assess the proportion of MDR-TB among SN-PTB patients registered in 2012 and the associated demographic and clinical factors. METHODS Study designThis was a retrospective cohort study using data routinely recorded in the national electronic TB register. SettingBelarus has a population of 9.5 million, with 72% living in urban areas. There are six administrative regions (Brest, Gomel, Grodno, Mogilev, Minsk and Vitebsk) and 121 districts. The Ministry of Health (MOH) oversees the implementation of TB control activities in the country. The Republican Scientific and Practical Centre for Pulmonology and Tuberculosis (RSPCPT) in Minsk is the central National Tuberculosis Programme (NTP) unit responsible for the development and implementation of TB policies. The Ministry of the Interior has...

Prevalence of tuberculosis, multidrug resistant tuberculosis and associated risk factors among smear negative presumptive pulmonary tuberculosis patients in Addis Ababa, Ethiopia

“…Our study showed higher SNMDR TB prevalence in comparison with a study in Iran among tuberculosis patients in between the year 2011–2013, which was 4.3% (2.38% in the new TB treatment group and 23.1% in the retreatment groups) [35]. The present study demonstrated low MDR TB prevalence as compared to a finding by a study in Belarus which was 47% SNMDR-TB: 33% among new and 73% among previously treated patients [15]. But, our study showed high prevalence of SNMDR TB in comparison with a study in India that was conducted among newly diagnosed sputum-positive pulmonary tuberculosis between February 2008 and December 2009 demonstrated very low prevalence that was 1.13% MDR-TB [36].…”

“…Smear negative pulmonary TB (SNPT) is a critical clinical and public health problem [11, 12]. This SNPT prevalence can reach 36 to 45% in United States of America [13], 65.2% in Brazil among high HIV prevalence setting (41.1%) [9], 68.1% in Italy [14], 55% in Belarus (from this 47% were smear negative MDR TB) [15]. Studies in Ethiopia have shown different evidences of SNPT prevalence.…”

Diagnostic performance of automated liquid culture and molecular line probe assay in smear-negative pulmonary tuberculosis

“…MDR phenotype or mono-resistance to INH or rifampicin was observed in an alarming proportion of our patients (12.4% of the recruited participants and 47.4% of the culture-positive participants). Previous studies have reported a varying range (10.8-50%) 18,19 of anti-tubercular drug resistance among sputum smear-negative participants. A wide variety of factors, including the endemicity of drug-resistant strains, the proportion of relapse and chronic cases, treatment defaulters and HIV-TB co-infected patients in the study group, and the TB prescription practices and compliance trends in the community can lead to a variable proportion of drug resistance in different studies.…”

Factors contributing to the high prevalence of multidrug-resistance/Rifampicin-resistance in patients with tuberculosis: an epidemiological cross sectional and qualitative study from Khabarovsk krai region of Russia

“…A study from Belarus performed in 2009 identified positive association between disability and MDR/RR-TB prevalence [ 35 ]. Concerning another type of social security policies, influence of retirement social status on the risk of MDR/RR-TB development is uncertain as both positive and negative relationships were reported in the literature [ 13 , 36 ]. A study conducted in Ethiopia revealed a tenfold increase in risk of MDR-TB for the military pensioners, explaining it as pensioners receive much fewer social benefits compared to the active military servicemen [ 13 ].…”