Control of (Multi) Drug Resistance and Tuberculosis Incidence over 23 Years in the Context of a Well-Supported Tuberculosis Programme in Rural Malawi
Control of (Multi) Drug Resistance and Tuberculosis Incidence over 23 Years in the Context of a Well-Supported Tuberculosis Programme in Rural Malawi
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DOI：
10.1371/journal.pone.0058192
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发表时间：
2013-03-06
期刊：
影响因子：
3.7
通讯作者：
Crampin, Amelia C.
中科院分区：
文献类型：
--
作者：
Mboma, Sebastian M.;Houben, Rein M. G. J.;Crampin, Amelia C.
背景：在广泛的艾滋病毒流行之后，结核病发病率的上升可能使资源有限的结核病控制方案不堪重负，有时还伴随着耐药率的上升。这导致声称，基于DOTS的结核病控制在这种情况下失败了。然而，很少有研究描述长期持续和得到良好支持的DOTS计划对结核病发病率和耐药性的影响。我们介绍了马拉维农村地区的发病率和耐药性的长期趋势。方法：马拉维北部的卡隆加区成人艾滋病毒感染率接近10%。一个名为卡隆加预防研究的研究小组与国家结核病方案合作，支持核心的结核病控制活动。自1988年以来，记录了该地区开始治疗结核病的所有患者的细菌学、人口学和临床信息(包括艾滋病毒情况)。在此期间，每个培养阳性结核病患者的分离株都被出口进行药敏试验。自2005年以来，抗逆转录病毒疗法(ART)已得到广泛应用。结果：90年代中期，新发涂阳成人结核病发病率达到124/10万/年，但此后下降到87/10万/年。95%(3132/3307)的培养阳性病例可获得药敏信息。最初对异烟肼的耐药率约为6%，没有增加的证据。不到1%的病例涉及多重耐药菌株。讨论：在艾滋病毒普遍流行和结核病负担中等的情况下，通过常规培养和药敏测试加强得到良好支持的DOTS计划很可能降低结核病发病率，并将耐药性保持在较低水平。
Background: The rise in tuberculosis (TB) incidence following generalized HIV epidemics can overwhelm TB control programmes in resource-limited settings, sometimes accompanied by rising rates of drug resistance. This has led to claims that DOTS-based TB control has failed in such settings. However, few studies have described the effect of a sustained and well-supported DOTS programme on TB incidence and drug resistance over a long period. We present long-term trends in incidence and drug resistance in rural Malawi.Methods: Karonga District in northern Malawi has an adult HIV prevalence of similar to 10%. A research group, the Karonga Prevention Study, collaborates with the National Tuberculosis Programme to support core TB control activities. Bacteriological, demographic and clinical (including HIV status) information from all patients starting TB treatment in the District have been recorded since 1988. During that period isolates from each culture-positive TB patient were exported for drug sensitivity testing. Antiretroviral therapy (ART) has been widely available since 2005.Results: Incidence of new smear-positive adult TB peaked at 124/100,000/year in the mid-90s, but has since fallen to 87/100,000/year. Drug sensitivity information was available for 95% (3132/3307) of all culture-positive cases. Initial resistance to isoniazid was around 6% with no evidence of an increase. Fewer than 1% of episodes involved a multi-drug resistant strain.Discussion: In this setting with a generalised HIV epidemic and medium TB burden, a well-supported DOTS programme enhanced by routine culture and drug sensitivity testing may well have reduced TB incidence and maintained drug resistance at low levels.