Author(s): Kenyon TA, Mwasekaga MJ, Huebner R, Rumisha D, Binkin N,
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Abstract SETTING: Botswana, southern Africa, where the tuberculosis (TB) case rate increased by 120\% from 1989 to 1996 in spite of a decade of implementation of the directly observed therapy, short-course (DOTS) strategy. OBJECTIVE: To determine prevalence of and risk factors for drug-resistant tuberculosis in an epidemic setting. DESIGN: Systematic national random survey of newly diagnosed pulmonary TB and all patients with TB requiring retreatment during 1995-1996. Interviews were conducted, human immunodeficiency virus (HIV) testing was offered, and drug susceptibility testing was performed for isoniazid, rifampicin, streptomycin and ethambutol. RESULTS: Resistance to at least one drug was identified in 16 (3.7\%) new cases and 18 (14.9\%) retreatment cases. One (0.2\%) new and seven (5.8\%) retreatment cases had resistance to at least both isoniazid and rifampicin (multidrug-resistant TB). Retreatment cases with multidrug-resistant TB were significantly more likely to have worked in the mines in South Africa than were cases with fully susceptible isolates (6/7 [85.7\%] versus 32/ 103 [31.1\%], odds ratio 13.3, 95\% confidence interval 1.5-311.0, P = 0.007). Of 240 patients tested for HIV, 117 (48.8\%) were positive; prevalence was similar among new and retreatment cases, and was not a risk factor for drug resistance in either group. CONCLUSION: During the HIV and TB co-epidemics in sub-Saharan Africa, DOTS may help to control drug-resistant TB. However, the TB case rate can be expected to continue to climb in spite of the implementation of the DOTS strategy.
This article was published in Int J Tuberc Lung Dis
and referenced in Biochemistry & Pharmacology: Open Access