Second nationwide anti-tuberculosis drug resistance survey in Namibia

Abstract

SUMMARY SETTING Namibia ranks among the 30 high TB burden countries worldwide. Here, we report results of the second nationwide anti-TB drug resistance survey. OBJECTIVE To assess the prevalence and trends of multidrug-resistant TB (MDR-TB) in Namibia. METHODS From 2014 to 2015, patients with presumptive TB in all regions of Namibia had sputum subjected to mycobacterial culture and phenotypic drug susceptibility testing (DST) for rifampicin, isoniazid, ethambutol and streptomycin if positive on smear microscopy and/or Xpert MTB/RIF. RESULTS Of the 4124 eligible for culture, 3279 (79.5%) had Mycobacterium tuberculosis isolated. 3126 (95%) had a first-line DST completed (2392 new patients, 699 previously treated patients, 35 with unknown treatment history). MDR-TB was detected in 4.5% (95%CI 3.7–5.4) of new patients, and 7.9% (95%CI 6.0–10.1) of individuals treated previously. MDR-TB was significantly associated with previous treatment (OR 1.8, 95%CI 1.3–2.5) but not with HIV infection, sex, age or other demographic factors. Prior treatment failure demonstrated the strongest association with MDR-TB (OR 17.6, 95%CI 5.3–58.7). CONCLUSION The prevalence of MDR-TB among new TB patients in Namibia is high and, compared with the first drug resistance survey, has decreased significantly among those treated previously. Namibia should implement routine screening of drug resistance among all TB patients.

The second national anti‐tuberculosis drug resistance survey in Tanzania, 2017–2018

“…In the current survey we report a slightly higher proportion of MDR-TB among female TB patients than among male TB patients, but this difference was not statistically significant. Similar findings were observed from the first national drug-resistant survey conducted in Ukraine, where the proportion of MDR-TB was higher among female TB patients than among male TB patients and this difference was statistically significant [27].…”

“…As such, 9% of all eligible individuals were not enrolled in the survey. However, despite this limitation, the survey results were consistent with the results from the previous survey in Tanzania [20] as well as with the results that have been reported in neighbouring countries [26,27]. Due to the high prevalence of HIV in Tanzania, and the fact that individuals living with HIV/AIDS were more likely to have smear negative TB than those without HIV, inclusion of smear negative specimens and the use of molecular techniques could be considered for future survey [36,37].…”

Clinical Evaluation of a Line-Probe Assay for Tuberculosis Detection and Drug-Resistance Prediction in Namibia

“…The estimated number of annual new cases is 12,000 (8,300–16,000), about 30% coinfected with HIV ( 1 , 9 , 10 ). MDR/RR-TB is present in 4.5% of new cases and 7.9% of previously treated cases ( 11 ). Xpert MTB/RIF (Cepheid, Sunnyvale, CA, USA) was introduced in 2017 (just before the start of this study) as a first-line TB diagnostic test in addition to sputum smear microscopy.…”

Whole-Genome Sequencing for Resistance Prediction and Transmission Analysis of Mycobacterium tuberculosis Complex Strains from Namibia

“…A TB prevalence survey in 2018 documented 465/100,000 prevalent cases ( 5 ). A recent drug resistance survey revealed MDR TB rates of 4.5% among new patients and 7.9% among previously treated patients ( 6 ). The overall number of new MDR TB cases per year is estimated to be around 800, while only 213 cases were detected in 2020 ( 4 ).…”