Adatu-Engwau, M

Ahoua, Laurence

Bonnet, Maryline

Bonte, L

Edemaga, D

Martin, A

Odama, A

Olson, D

Omale, W

Sauvageot, D

Umutoni, C

English

MSF Field Research

Anti Anti- -tuberculosis drugs resistance survey in West Nile, Uganda  tuberculosis drugs resistance survey in West Nile, Uganda 
Laurence Ahoua1, Delphine Sauvageot1, Daniel Edemaga2; Anandi Martin3,4, Chantal Umutoni2, Alex Odama5, William Omale6, David Olson4, Laurence Bonte4, 
Francis Adatu-Engwau5, Maryline Bonnet1
1Epicentre,  France;  2MSF, Uganda; 3Tropical Medical Institute, Antwerp Belgium; 4MSF,France; 5National Leprosy and Tuberculosis Program, Uganda; 6Arua Regional Referral Hospital, Uganda;
Background  Background 
• Multidrug resistance (MDR)  in HIV co-infected patients
• Increase of nosocomial transmission
• High case fatality rate
• MDR poorly documented in Sub-Saharan countries where 
majority of TB cases are HIV co-infected
• Emergence of MDR and Extreme-drug resistance (XDR)  
epidemics in Kwazulu Natal (Gandhi et al, Lancet.2006) 
• MDR-TB likely to be underestimated 
• North western Uganda 
- National adult HIV prevalence rate was of 6.7% in 2005
- Drug Susceptibility Testing survey in Uganda
○ 1996-97 (national): 0.5% MDR prevalence in new cases (NC) and 4.4% in previously treated cases (PTC)
○ 2000 (hospital-based study in Kampala): 4.7% MDR TB in NC, among those 70% HIV co-infected
• HIV and TB program supported by Médecins Sans Frontières in West Nile region (north-western Uganda) 
- MDR treatment available in Arua regional referral Hospital
Objectives Objectives Methods Methods
• Primary objective
- To measure the MDR prevalence in overall new smear 
patients and HIV co-infected ones
• Secondary objectives
- To describe the 1st line drug resistance patterns of NC and 
PTC
- To describe resistance to 2nd line drugs and XDR resistance 
among MDR-TB cases
• Cross-sectional survey of all consecutive smear positive patients in the TB centers of the Western Nile region 
• TB Case and Drug resistance definitions based on WHO/IUATLD standards definitions (WHO, 2006)
• Sample size: N = 400 NC 
• Laboratory procedures
- Collection of 2 sputum samples 
- Samples shipped to the Tropical Medical Institute (Antwerp)
○ Culture & DST 1st line on Lowenstein Jensen (LJ) or MGIT
○ DST 2nd line on agar 7H11: proportion method
Preliminary Preliminary results results
Baseline patient characteristics Geographical origin (West Nile region)
70 (41.4)
82 (48.5)
17 (10.1)
Age , year
15-29
30-44
≥ 45
n (%) Patients’ characteristics
146 (86.4)
23 (13.6)
2 (8.7)
14 (60.9)
6 (26.0)
1 (4.4)
Type of TB
New case
Previously treated case
Failure
Relapse
RAD
Other
61 (36.1%)
94 (55.6%)
14 (8.3)
HIV status
Positive
Negative
Refused testing
120 (71.0) Males
Culture results Drug Sensitivity Testing results
13.6 3 - 0.0 0 0.6-6.3 2.1 3 MDR
4.5 1 - 0.0 0 0.1 - 4.8 0.7 1 HR
4.5 1 - 0.0 0 0.1 - 4.8 0.7 1 HRS
0.0 0 0.4 - 6.4 1.6 2 0.3 - 5.4 1.4 2 MonoE
0.0 0 4.4 - 14.6 8.1 10 3.7 - 12.4 6.9 10 MonoS
27.3 6 3.3 - 12.6 6.5 8 5.8 - 15.7 9.3 14 MonoH
0.0 0 - 0.0 0 - 0.0 0 MonoR
0.0 0 - 0.0 0 - 0.0 0 R+E+S
4.5 1 - 0.0 0 0.1 - 4.8 0.7 1 R+S
0.0 0 - 0.0 0 - 0.0 0 R+E
0.0 0 0.8 - 7.4 2.4 3 0.1 - 6.3 2.1 3 H+E+S
0.0 0 2.2 - 10.5 4.9 6 1.8 - 9.0 4.1 6 H+S
0.0 0 0.1 - 5.7 0.8 1 0.1 - 4.8 0.7 1 H+E
13.6 3 10.0 - 23.1 15.4 19 10.2 - 22.1 15.2 22 Any S
4.5 1 2.2 - 10.5 4.9 6 2.3 - 9.9 4.8 7 Any E
18.2 4 - 0.0 0 1.0 - 7.2 2.8 4 Any R
40.9 9 9.4 - 22.2 14.6 18 13.0 - 25.9 18.2 27 Any H
Other patterns
4.5 1 - 0.0 0 0.1 - 4.8 0.7 1 HRES
54.6 12 63.7-79.6 72.4 89 61.6-76.7 69.7 101 Full susceptible 
22 123 145 Nb of cases tested
% n 95%CI % n 95%CI % n
PTC NC GLOBAL
Discussion Discussion
Main findings
• 86% NC and 36% being HIV co-infected 
 Low MDR-TB prevalence, only in PTC 
 No XDR 
• High rate of primary isoniazid resistance (14.6%)
• No difference of drug sensitivity in HIV+ and HIV- patients
Operational issues for the National program
• Low MDR rate: DST would be recommended only in failures of standard 1st line drugs regimens
• 4 months RH continuation phase might be not enough to assure patients with primary H resistance 
and might induce R resistance amplification
• Completion of the survey end of 2009
 
Nyapea 
Nebbi District 
Hospital 
Angal 
Yumbe 
Moyo 
Adjumani 
Aru (DRC) 
ARUA 
KOBOKO 
COUNTY 
 
MARACHA 
COUNTY 
AYIVU COUNTY 
VURRA COUNTY 
 
TERREGO COUNTY 
MADDI OKOLLO 
COUNTY 
N EBBI 
D ISTRICT 
 
A DJUMANI 
D ISTRICT 
 
Y UMBE 
D ISTRICT 
ARUA MUNICIPALITY 
 
Koboko 
Midigo 
Maracha 
Kuluva 
Yumbe 
Pakwach
b  
Congo: n=14 (9%)
Yumbe:
n=1 (0.7%)
Moyo:
n=1 (0.7%)
Nebbi:
n=4 (2.6%)
Agjumani:
n=1 (0.7%) Koboko:
n=5 (3.2%)
Maratcha:
n=3 (1.9%)
Arua:
n=116 (74.9%)
151 13 4 134 Total
2 1 0 1 Contaminated
18 2 3 13 Neg
131 10 1 120 Pos
Total Contaminated Neg Pos LJ
MGIT
•No XDR detected. 
•Of the 3 MDR patients : 1 was resistant to Ethionamide and 1 was resistant to Pyrazinamide
•A total of 169 patients were included in the DST survey (September 2007 - October 2008).
•Gender, age group and type of TB were not statistically different according to the HIV status.
Of the 169 patients included: 16 had ongoing culture analysis, 2 had non analysable sputum 
samples. 
Drug Sensitivity Testing by HIV status
3
12
2 1
1
14
13
0
5
10
15
20
25
30
Any R Any H MDR HE(S)
N
b
 
o
f
 
p
a
t
i
e
n
t
s HIV-neg
HIV-Pos

Anti-tuberculosis drug resistance survey in West Nile, Uganda

Anti-tuberculosis drug resistance survey in West Nile, Uganda

Abstract

Similar works

Full text

Available Versions

MSF Field Research