Is multidrug-resistant tuberculosis on the rise in Mozambique? Results of a national drug resistance survey

Abstract

takes place only once the tubes are in the laboratory. If we consider only the samples sent from regional or remote sources, the rate of indeterminate test result is still very low (one (0.3%) out of 317). The use of T-Cell Xtend TM for all samples shipped overnight is likely to have had a beneficial effect on older samples. The cold weather conditions had no influence on the rate of indeterminate results (all samples were sent and processed in winter). The number of tests performed in very young or very old patients being small, we cannot assess the rate of indeterminate in these population groups.The slightly higher rate of positivity in samples referred from Vaud county (17% versus 10% in other groups) can be explained since these samples were mostly from recent immigrants from countries with a high prevalence of tuberculosis, whereas the samples from the city or from remote places were more often taken for contact tracing investigations where the rate of infection may be expected to be lower.In conclusion, these results demonstrate that the use of lithium heparinate blood collection tubes for all samples and T-Cell Xtend TM for samples shipped overnight allows the processing of samples from all over Switzerland while maintaining the rate of indeterminate test results at a very low level in spite of longer travel time (8-36 h). In our experience, the only indeterminate test results are observed in patients with some immune abnormality and do not represent a laboratory failure.

A meta-analysis of Drug resistant Tuberculosis in Sub-Saharan Africa: How Strongly Associated with previous Treatment and HIV Co-infection?

“…As presented in Fig.3, except for two studies (from Swaziland and Mozambique) (23, 33), all other studies showed the association of MDR-TB to HIV positives or HIV negatives with an overall RR of 1.0 and 95% CI, 0.78 to 1.36. When any of the studies were withdrawn from the analysis, the overall risk ratio ranged between 0.94 and 1.06.…”

“…However, when we look at the findings in the individual studies, fewer resistant cases were found with ethambutol in the new than in the previously TB treated cases (15–17, 20, 23, 29, 31, 33, 39). Could its bacteriostatic nature (mycobacterial cell wall biosynthesis inhibition) explain why Mycobacterium TB strains became highly resistant to ethambutol among the previously treated?…”

Implementation challenges of a TB programme in rural northern mozambique: evaluation of 2012–2013 outcomes

“…This further suggests that rural areas might act as a possible source for the generation of multi drug-resistant TB (MDR-TB), given higher drug resistance rates have been repeatedly described in retreatment cases. 14,15 Tuberculosis programmes in rural areas have been scarcely reported although the knowledge of the epidemiologic situation in such areas is key to design and implement TB control policies. 16 We aimed to evaluate the outcomes and identify implementation challenges of the TB programme in a remote rural African district.…”

Programmatic and ethical challenges in the implementation of treatment-as-prevention in the context of HIV and drug-resistant tuberculosis co-infection in sub-Saharan Africa

“…In 2011, an estimated 440,000 new cases of MDR-TB occurred worldwide, but only about 13% of these cases were detected and subsequently enrolled in treatment (Stop TB Partnership, 2012). National studies from Mozambique (Samo Gudo et al, 2011) and Swaziland (Sanchez-Padilla et al, 2012) reported that the proportion of MDR-TB infections was significantly higher among PLH, when compared to HIVuninfected individuals. Further, Sanchez-Padilla and colleagues (2012) found that PLH were twice as likely to be infected with MDR-TB when compared to HIV-negative individuals.…”