ABSTRACT
SETTING: Rwanda has generalised human immunodeficiency virus (HIV) and tuberculosis (TB) epidemics. The Rwandan Ministry of Health approved a policy on TB-HIV collaborative activities in 2005. The present study is a report on the results of the integrated TB and HIV activities at a rural health care site between July 2005 and June 2006. METHODS: Activities included provider-initiated HIV testing and counselling (PITC) of TB patients and the implementation of a standardised TB screening questionnaire for in-patients on medical wards and HIV-infected out-patients. RESULTS: Of a total 259 TB patients registered, 87% with unknown HIV status or who were HIV-negative accepted PITC. Overall, 48% (125/259) of TB patients were HIV-infected. The proportion of TB patients ever tested for HIV increased from 82% (138/169) in 2004-2005 to 93% (240/259) in 2005-2006 (P < 0.001). Of the 770 in-patients screened for TB, 162 (21%) tested positive, of whom 53 (33%) were diagnosed with TB; 39 (76%) of these were HIV co-infected. Three hundred out-patients with HIV were screened for TB; 80 (27%) tested positive, of whom 11 (14%) were diagnosed with TB. DISCUSSION: Activities integrating TB and HIV were feasible in a rural health care setting. PITC was successful in TB patients and unrecognised TB was common, particularly among HIV-infected in-patients.
Subject(s)
Delivery of Health Care, Integrated/organization & administration , HIV Infections/therapy , Tuberculosis/therapy , AIDS Serodiagnosis , Directive Counseling , HIV Infections/complications , HIV Infections/epidemiology , HIV Seropositivity , Humans , Mass Screening/methods , National Health Programs/organization & administration , Rural Health Services/organization & administration , Rwanda/epidemiology , Surveys and Questionnaires/statistics & numerical data , Tuberculosis/complications , Tuberculosis/epidemiologyABSTRACT
This study was undertaken within the framework of a surveillance project on the resistance of Mycobacterium tuberculosis to first-line antituberculosis drugs in four provinces of Rwanda with a high prevalence of tuberculosis (TB). The purpose was to determine the prevalence of primary and acquired resistance of M. tuberculosis to major antituberculosis drugs. A cohort of patients (n=710) with pulmonary TB documented by positive microscopic examinations of exhaustive samples was recruited at 7 treatment centers. Sputum samples were cultured on Löwenstein-Jensen and Coletsos media. Sensitivity to antituberculosis drugs was tested using a BACTEC 460 radiometric system. M. tuberculosis was isolated in 644 of the 710 patients (90.7%). A total of 296 out of 573 tested for HIV infection (51.7%) were positive. Primary resistance to one, two, three or four antituberculosis drugs was observed in 3.5%, 2.9%, 1.4% and 5.7% respectively. The prevalence of acquired resistance to antituberculosis drugs was 11.2%. Primary monoresistance to streptomycin was the most prevalent (2.3%) followed by resistance to ethambutol (1%). The combined rate of multiresistance was 11.6% with 7% involving new cases and 25.5% involving retreatment. This study showed that the rates of primary and acquired resistance to first-line antituberculosis drugs were high and that TB was associated with HIV infection. The National TB Control Program must implement measures to coordinate diagnosis and management of TB and HIV infection.
Subject(s)
Drug Resistance, Multiple, Bacterial , Tuberculosis, Pulmonary/drug therapy , Adult , Antitubercular Agents/therapeutic use , Female , Humans , Male , Mycobacterium tuberculosis , Prospective Studies , Retreatment , Rwanda/epidemiologyABSTRACT
BACKGROUND: One of the principal objectives of tuberculosis (TB) control is to minimise the emergence of drug resistance. The first national survey was conducted in Rwanda to determine the prevalence of M. tuberculosis drug resistance. METHODS: Sputum samples were collected from all new and retreatment cases in the health districts from November 2004 to February 2005. Drug susceptibility testing of isolates against first-line drugs was performed by the proportion method. RESULTS: Of 616 strains from new cases, 6.2% were resistant to isoniazid, 3.9% to rifampicin and 3.9% were multidrug-resistant TB. Among 85 strains from previously treated cases, the prevalence of resistance was respectively 10.6%, 10.6% and 9.4% (MDR-TB strains). Eight MDR cases showed additional resistance to ethambutol and streptomycin. CONCLUSION: The level of MDR-TB among TB patients in Rwanda is high. The main reasons of this emergence of MDR-TB can be attributed to the disorganisation of the health system, migration of the population during the 1994 civil war and poor success rates, with a high number of patients transferred out and lost to follow-up. On the other hand, the use of treatment regimens administered twice weekly during the continuation phase could be another important factor and merit further investigations.
Subject(s)
Antitubercular Agents/pharmacology , Drug Resistance, Multiple, Bacterial , Mycobacterium tuberculosis/drug effects , Tuberculosis, Pulmonary/drug therapy , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Ethambutol/pharmacology , Female , Health Surveys , Humans , Isoniazid/pharmacology , Male , Middle Aged , Rifampin/pharmacology , Rwanda , Streptomycin/pharmacology , Tuberculosis, Pulmonary/prevention & control , WarfareABSTRACT
Le cadre de l'etude de la resistance de Mycobacterium tuberculosis aux antituberculeux de premiere ligne se situe dans quatre provinces du Rwanda a forte prevalence de tuberculose (TB). L'objectif etait de determiner les prevalences de resistance primaire et acquise de M. tuberculosis aux antituberculeux majeurs. Une cohorte de patients avec TB pulmonaire a microscopie positive (n=710) echantillonnes de maniere exhaustive a ete incluse entre septembre 2002 et mars 2004 dans 7 centres de traitement. Leurs expectorations ont ete ensemencees sur milieux de Lowenstein-Jensen et Coletsos. La sensibilite aux antituberculeux a ete testee par la methode radiometrique BACTEC 460. Sur 710 malades;M. tuberculosis a ete isole chez 644 (90;7). Parmi eux; 296/573 (51;7) etaient positifs pour le VIH. La resistance primaire a un; deux; trois ou quatre antituberculeux etait de 3;5; 2;9; 1;4et 5;7respectivement. La resistance acquise a un antituberculeux etait de 11;2. La monoresistance primaire a la streptomycine etait la plus frequente (2;3); suivie de la resistance a l'ethambutol (1). Le taux combine de multiresistance representait 11;6; avec 7chez les nouveaux cas et 25;5chez les re-traites. Les taux de resistance primaire et acquise aux antituberculeux de premiere ligne sont eleves et la TB est associee au VIH. Le Programme National de lutte contre la TB devrait mettre en place une bonne coordination dans le diagnostic et la prise en charge de la TB et de l'infection par le VIH
Subject(s)
HIV , Drug Resistance, Bacterial , Mycobacterium tuberculosisABSTRACT
Le cadre de l'etude de la resistance de Mycobacterium tuberculosis aux antituberculeux de premiere ligne se situe dans quatre provinces du Rwanda a forte prevalence de tuberculose (TB). L'objectif etait de determiner les prevalences de resistance primaire et acquise de M. tuberculosis aux antituberculeux majeurs. Une cohorte de patients avec TB pulmonaire a microscopie positive (n=710) echantillonnes de maniere exhaustive a ete incluse entre septembre 2002 et mars 2004 dans 7 centres de traitement. Leurs expectorations ont ete ensemencees sur milieux de Lowenstein-Jensen et Coletsos. La sensibilite aux antituberculeux a ete testee par lamethode radiometrique BACTEC 460. Sur 710malades;M. tuberculosis a ete isole chez 644 (90;7). Parmi eux; 296/573 (51;7) etaient positifs pour leVIH. La resistance primaire a un; deux; trois ou quatre antituberculeux etait de 3;5; 2;9; 1;4et 5;7respectivement. La resistance acquise a un antituberculeux etait de 11;2. La monoresistance primaire a la streptomycine etait la plus frequente (2;3); suivie de la resistance a l'ethambutol (1). Le taux combine de multiresistance representait 11;6; avec 7chez les nouveaux cas et 25;5chez les re-traites. Les taux de resistance primaire et acquise aux antituberculeux de premiere ligne sont eleves et la TB est associee au VIH. Le Programme National de lutte contre la TB devrait mettre en place une bonne coordination dans le diagnostic et la prise en charge de la TB et de l'infection par le VIH
