ABSTRACT
OBJECTIVES: To determine the prevalence and risk factors associated with rifampicin (RIF)-resistant tuberculosis using GeneXpert technology. METHODS: A cross-sectional study was conducted from April 2018 to November 2019 among tuberculosis (TB)-infected Cameroonian patients in the Littoral Region using records from patients presenting with clinically suspected or documented TB. The patients were screened for TB using GeneXpert MDR/RIF ultra. Data were documented with an ad hoc survey form and analysed with SPSS version 22. RESULTS: 153 patients were included in the study. 64.1% were males; mean age was 37.9 ± 14.7 years and median age 37 years (range: 2-82). Most patients were new cases (76.4%). Relapses accounted for 8.5% and recurrences for 2.6%. Pulmonary TB was diagnosed among 98.7% patients using mostly sputum samples (85%). The prevalence of RIF resistance was 6.7% (95% CI: 3.4%-12.7%). This prevalence was significantly higher in samples of mucus and mucopurulent aspect (P-value = 0.04). RIF-resistant M. tuberculosis strains were significantly more frequent among relapses than new cases (23.1% vs. 2.3% P-value < 0.0001). A statistically significant association was found between GeneXpert-based quantification results and type and aspect of samples. CONCLUSION: This study confirms the circulation of RIF-resistant M. tuberculosis strains in the Littoral region. There is a need for extensive studies in other parts of the country.
Subject(s)
Drug Resistance, Bacterial , Mycobacterium tuberculosis/drug effects , Mycobacterium tuberculosis/isolation & purification , Rifampin/therapeutic use , Tuberculosis, Pulmonary/drug therapy , Adolescent , Adult , Aged , Aged, 80 and over , Antibiotics, Antitubercular/therapeutic use , Cameroon , Child , Child, Preschool , Cross-Sectional Studies , Female , Hospitals , Humans , Male , Middle Aged , Mycobacterium tuberculosis/genetics , Recurrence , Sensitivity and Specificity , Sequence Analysis, DNA/methods , Sputum/microbiology , Tuberculosis, Pulmonary/diagnosis , Young AdultABSTRACT
BACKGROUND: Tuberculosis (TB) is a public health concern, especially in resource-constrained countries like Cameroon. TB drug resistance is a major obstacle to control and prevent. DESIGN: Data from 2014 to 2016 on the outcome of anti-TB treatment in the Littoral Region were reviewed manually and analysed using the meta-analysis concept. The treatment success rates (TSR) were the primary outcome used for this study. The heterogeneity statistics (I 2) was computed to orientate the choice of the best statistical model (binary fixed effect or random) to compute pooled value of TSR. RESULTS: Using an intention-to-treat analysis, the pooled proportions of HIV-uninfected TB patients successfully cured from TB were low and slightly decreased by 1% between 2014 and 2016. Regarding HIV-infected TB patients, pooled values of TSR were lower than those of their HIV-negative counterparts with values ranging from 71% (95% CI: 63%-83%; I 2 = 71.16%) in 2014 to 68% (95% CI: 58%-79%; I 2 = 70.97%) in 2016. In addition, no heterogeneity was found in three years (I 2 = 0.0%; P value = 1). These cure rates were strongly and negatively correlated with the rates of patients lost to follow-up regardless of the year. In HIV-infected patients, the pooled values of ITT analysis-based treatment success rates were 73% (χ 2 = 13.92, P value = 0.0002), 71% (χ 2 = 7.26, P value = 0.007), and 68% (χ 2 = 8.02, P value = 0.004), respectively. The coverage rates with cotrimoxazole (CTX) gradually increased over year ranging from 78.90% in 2014 to 94.17% in 2016, similar to the coverage rate for ARV therapy that was 60.06% in 2014 against 90% in 2016. A positive and statistically significant correlation was found between the success of the anti-TB therapy in HIV-infected patients and coverage rates with CTX and ARV. CONCLUSION: An improvement in the reduction of percentage of lost to follow-up and coverage with CTX and ARV therapy could greatly increase chances to efficiently control TB in Cameroon.
