Surveillance of Rifampicin Resistance With GeneXpert MTB/RIF in the National Reference Laboratory for Tuberculosis at the Institut Pasteur in Bangui, 2015–2017

Abstract

Background The Central African Republic (CAR) has one of the heaviest burdens of tuberculosis (TB) in the world, with an incidence of 423 cases per 100 000 population. Surveillance of resistance to rifampicin with GeneXpert MTB/RIF was instituted in the National TB Reference Laboratory in 2015. The aim of this study was to evaluate, after 3 years, resistance to rifampicin, the most effective firstline drug against TB. Methods The surveillance database on cases of rifampicin resistance was retrospectively analyzed. The populations targeted by the National TB Programme were failure, relapse, default, and contacts of multidrug-resistant TB (MDR-TB). Statistical analyses were performed with Stata software, version 14, using chi-square tests and odds ratios. Results Six hundred seventeen cases were registered; 63.7% were male, 36.3% were female, and the mean age was 35.5 years (range from 2 to 81). GeneXpert MTB/RIF tests were positive in 79.1% (488/617), and resistance to rifampicin was positive in 42.2% (206/488), with 49.1% (56/114) in 2015, 34.7% (57/164) in 2016, and 44.3% (93/210) in 2017. Failure cases had the highest rate of resistance (70.4%), with a significant difference (P < .0001; odds ratio, 9.5; 95% confidence interval, 4.4–20.5). Resistance was observed in 40% of contacts of MDR-TB, 28.2% of the relapses and 20% of the defaults without significant difference. Conclusions Resistance to rifampicin is still high in the CAR and is most strongly associated with treatment failure. The Ministry of Health must to deploy GeneXpert MTB/RIF tests in the provinces to evaluate resistance to TB drugs in the country.

Trends of Mycobacterium tuberculosis and rifampicin resistance in Adigrat General Hospital, Eastern zone of Tigrai, North Ethiopia

“…Our finding was similar to studies conducted in the Debre Markos Hospital (23.2%) [15], Gondar Referral Hospital (24.6%) [16], Gambella (20.0%) [17], Afar (24.5%) [18], India (27.6%) [4], South Africa (26%) [19], Nigeria (22.9%) [20] And the WHO report in Africa (25%) [2]. However, it was lower compared to reports in Jigjiga (65.5%) [21], Kenya (32.25%) [22], in eastern Uttar Pradesh (32.9%) [23] and Congo (79.1%) [24]. The main difference in these latter findings may show our inclusion of all forms of presumptive tuberculosis while other studies included identified cases of Mycobacterium tuberculosis.…”

Trends of Mycobacterium Tuberculosis and rifampicin resistance in Adigrat General Hospital, Eastern Zone of Tigrai, North Ethiopia

“…According to our study, we found 132 (9.1%) of rifampicin-resistant cases among con rmed TB cases. This result is comparable with studies conducted in Debre Markos Referral Hospital (10.3%) [13], Felege Hiwot Referral Hospital and Debre Tabor Hospital (9.3%) [20], Addis Ababa (9.9 %) [48] and India (10.5%) [38].Our nds are higher than studies conducted on northwest, east and south parts of Ethiopia (2.9%-5.7%) [6,19,31-32,39,42,46 and 48], Nigeria (2.9%) [24] and Zambia (5.9%) [33].The possible explanation for these variations could be related to our retrospective approach spanning four years, or differences in study designs .However, our incidence was lower than for studies conducted in Gondar 15.8% [14],other parts of Ethiopia (11.5-39.4) [39-40and 51],Congo (42.2%) [47] and China (17.6-26.3%) [43 and 50].…”

“…Our nding was similar to studies conducted in the Debre Markos Hospital (23.2%) [13], Gondar Referral Hospital (24.6%) [14], Gambella (20.0%) [46], Afar (24.5%) [49], India (27.6%) [4], South Africa (26%) [15], Nigeria (22.9 %) [16] And the WHO report in Africa (25%) [2]. However, it was lower compared to reports in Jigjiga (65.5%) [17], Kenya (32.25%) [18], in eastern Uttar Pradesh (32.9%) [19] and Congo (79.1%) [47].The main difference in these latter ndings may show our inclusion of all forms of presumptive tuberculosis while other studies included identi ed cases of Mycobacterium tuberculosis. In contrast, our nding was higher when compared with studies conducted in Metema and Armacho (5.7%) [6], Felege Hiwot Referral Hospital, and Debre Tabor Hospital (14.6%) [20], in three referral hospitals and the regional laboratory in Addis Ababa (15.11%) [48], other parts of Ethiopia (4.7%-10.8%) [21][22][23], Nigeria (10.3%) [24] and India (2.31%) [25].The variations might be due to the difference in study design, type and number of participants, and environmental conditions.…”

Trends of Mycobacterium Tuberculosis and Rifampicin resistance in Adigrat General Hospital, Eastern zone, Tigray Region, Northern Ethiopia

“…This result is comparable with studies conducted in Debre Markos Referral Hospital (10.3%) [13], Felege Hiwot Referral Hospital and Debre Tabor Hospital (9.3%) [20], Addis Abeba (9.9 %) [48] and India (10.5%) [38]. our finds are higher than earlier studies conducted on different parts of Ethiopia (2.9%-5.7%) [6,19,31-32,39,42,46 & 48], Nigeria (2.9%) [24] and Zambia (5.9%) [33].The possible explanation for these variations could be related to our retrospective approach spanning four years, or differences in study designs .However, our prevalence was lower than for studies conducted in Gonder 15.8% [14], other parts of Ethiopia (11.5-39.4 [39-40 & 51], Congo (42.2%) [47] and China…”

“…Our finding was similar to studies conducted in the Debre Markos Hospital (23.2%) [13], Gondar Referral Hospital (24.6%) [14], Gambella (20.0%) [46], Afar (24.5%) [49], India (27.6%) [4], South Africa (26%) [15], Nigeria (22.9 %) [16] And the WHO report in Africa (25%) [2]. However, it was lower compared to reports in Jigjiga (65.5%) [17], Kenya (32.25%) [18], in eastern Uttar Pradesh (32.9%) [19] and Congo (79.1%) [47]. the main difference in these latter findings may show our inclusion of all forms of presumptive tuberculosis while other studies included identified cases of Mycobacterium tuberculosis.…”