Tuberculosis Treatment Outcome and Drug Resistance in Lambaréné, Gabon: A Prospective Cohort Study

Abstract

Abstract. Despite overall global progress in tuberculosis (TB) control, TB remains one of the deadliest communicable diseases. This study prospectively assessed TB epidemiology in Lambaréné, Gabon, a Central African country ranking 10th in terms of TB incidence rate in the 2014 World Health Organization TB report. In Lambaréné, between 2012 and 2014, 201 adult and pediatric TB patients were enrolled and followed up; 66% had bacteriologically confirmed TB and 95% had pulmonary TB. The human immunodeficiency virus (HIV) coinfection rate was 42% in adults and 16% in children. Mycobacterium tuberculosis and Mycobacterium africanum were identified in 82% and 16% of 108 culture-confirmed TB cases, respectively. Isoniazid (INH) and streptomycin yielded the highest resistance rates (13% and 12%, respectively). The multidrug resistant TB (MDR-TB) rate was 4/91 (4%) and 4/13 (31%) in new and retreatment TB cases, respectively. Treatment success was achieved in 53% of patients. In TB/HIV coinfected patients, mortality rate was 25%. In this setting, TB epidemiology is characterized by a high rate of TB/HIV coinfection and low treatment success rates. MDR-TB is a major public health concern; the need to step-up in-country diagnostic capacity for culture and drug susceptibility testing as well as access to second-line TB drugs urgently requires action.

Implementation of multidrug-resistant tuberculosis (MDR-TB) treatment in Gabon: lessons learnt from the field

“…In Singapore, Indonesia and other South East Asian countries, the figure would be 30% [14]; of the other regions examined, only Brazil would yield 50-55% eligible patients [15]. However, with until recently an almost complete absence of second-and third-line TB drugs [3], our setting renders patient cohorts such as the one presented here as an ideal candidate for the abridged WHO regimen, which is in situations where due to previous lack of access to second-line treatments, resistance to second-line drugs is by-and-large absent.…”

“…MDR-TB represents an emerging public health concern in Gabon. Despite the increasing number of cases, few, if any, treatment options were available in the country until recently [2,3,10]. Here, we report on the outcome of a pilot treatment phase that aimed to introduce and implement the 9-12 month short-regimen scheme before its endorsement by the WHO in May 2016 [7].…”

“…countries, patients often only have very limited access to MDR-TB treatment and data are still scarce on incidence, prevalence, molecular characteristics, treatment, and outcome [1]. In Gabon, despite case reports of treatment failure to the first-line TB therapy [2], it was only in 2013 that a more comprehensive assessment of the epidemiology of MDR-TB was conducted for the first time [3]. This study, carried out in Lambaréné, a semi-urban town of around 30.000 inhabitants, indicated an MDR rate of 4/91 (4%) and 4/13 (31%) in new and retreatment TB cases, respectively [3].…”

“…In Gabon, despite case reports of treatment failure to the first-line TB therapy [2], it was only in 2013 that a more comprehensive assessment of the epidemiology of MDR-TB was conducted for the first time [3]. This study, carried out in Lambaréné, a semi-urban town of around 30.000 inhabitants, indicated an MDR rate of 4/91 (4%) and 4/13 (31%) in new and retreatment TB cases, respectively [3]. This rate is quite high and is comparable to prevalences reported from highly MDR-TB endemic countries [4,5].…”

Directly observed therapy and risk of unfavourable tuberculosis treatment outcomes among an international cohort of people living with HIV in low‐ and middle‐income countries

“…In 2016, TB treatment success rates were 82% overall but only 77% for HIV‐associated TB . TB re‐treatment, in turn, is associated with even higher rates of unfavourable TB treatment outcomes (including death, recurrence and failure) , drug resistance , and more complicated and costly drug regimens.…”