Prevalence of Extensively Drug Resistant Tuberculosis among Archived Multidrug Resistant Tuberculosis Isolates in Zimbabwe

We conducted a cross-sectional study of second line drug resistance patterns and genetic diversity of MDR-TB isolates archived at the BRTI-TB Laboratory, Harare, between January 2007 and December 2011. DSTs were performed for second line antituberculosis drugs. XDR-TB strains were defined as MDR-TB strains with resistance to either kanamycin and ofloxacin or capreomycin and ofloxacin. Strain types were identified by spoligotyping. No resistance to any second line drugs was shown in 73% of the isolates, with 23% resistant to one or two drugs but not meeting the definition of XDR-TB. A total of 26 shared types were identified, and 18 (69%) matched preexisting shared types in the current published spoligotype databases. Of the 11 out of 18 clustered SITs, 4 predominant (>6 isolates per shared type) were identified. The most and least abundant types were SIT 1468 (LAM 11-ZWE) with 12 (18%) isolates and SIT 53 (T1) with 6 (9%) isolates, respectively. XDR-TB strains are rare in Zimbabwe, but the high proportion of "pre-XDR-TB" strains and treatment failure cases is of concern. The genetic diversity of the MDR-TB strains showed no significant association between SITs and drug resistance

Ungrouped religious affiliations of survey participants.

<p>Ungrouped religious affiliations of survey participants.</p

Socio-demographic and sexual behaviour profiles of religious groups in 1998–2000 and in 2003–2005 in Manicaland, Zimbabwe: males.

**<p>p<0.001.</p>*<p>p<0.05.</p><p>Difference in behaviour variable in religious group versus Christians adjusted for age using logistic regression. Variables converted to binary variables:Variables converted to binary variables:</p><p>Lifetime sexual partners: 1&2 versus 3+; no. of sexual partners in 12 months: 0&1 versus 2+; condom use: never and less than a year vs. more than a year.</p>†<p>Married before age 18 years.</p

Comparison of HIV prevalence between religions over time, Manicaland, Zimbabwe: univariate and nested multivariate regression models for 1998–2000 and 2003–2005: males.

<p>Comparison of HIV prevalence between religions over time, Manicaland, Zimbabwe: univariate and nested multivariate regression models for 1998–2000 and 2003–2005: males.</p

Differences in HIV prevalence between long-term and new female church members by major religious grouping (2003–2005).

<p>aOR, odds of HIV infection adjusted for age-group, education and marital status.</p

Principal teachings and practices of major religious groupings in Manicaland, Zimbabwe.

<p>Principal teachings and practices of major religious groupings in Manicaland, Zimbabwe.</p

Sensitivity analyses.

<p>Impact and cost-effectiveness of Zimbabwe’s VMMC program under alternative assumptions for key parameters whose values are uncertain.</p

Projected impact of the VMMC program over 2016–2030, with VMMC scale-up embedded within broader scale-up of HIV prevention and treatment, according to the global Fast Track targets, evaluated relative to the counterfactual scenario in which the Fast Track targets for other interventions are met without VMMC.

<p>Projected impact of the VMMC program over 2016–2030, with VMMC scale-up embedded within broader scale-up of HIV prevention and treatment, according to the global Fast Track targets, evaluated relative to the counterfactual scenario in which the Fast Track targets for other interventions are met without VMMC.</p

VMMC scale-up scenarios evaluated.

<p>VMMC scale-up scenarios evaluated.</p