Detection and management of drug-resistant tuberculosis in HIV-infected patients in lower-income countries

M Ballif, V Nhandu, R Wood, J C Dusingize, E J Carter, C P Cortes, C C McGowan, L Diero, C Graber, L Renner, D Hawerlander, S Kiertiburanakul, Q T Du, T R Sterling, M Egger, L Fenner, International epidemiological Databases to Evaluate AIDS (IeDEA), Morten Sodemann

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SETTING: Drug resistance threatens tuberculosis (TB) control, particularly among human immunodeficiency virus (HIV) infected persons.

OBJECTIVE: To describe practices in the prevention and management of drug-resistant TB under antiretroviral therapy (ART) programs in lower-income countries.

DESIGN: We used online questionnaires to collect program-level data on 47 ART programs in Southern Africa (n = 14), East Africa (n = 8), West Africa (n = 7), Central Africa (n = 5), Latin America (n = 7) and the Asia-Pacific (n = 6 programs) in 2012. Patient-level data were collected on 1002 adult TB patients seen at 40 of the participating ART programs.

RESULTS: Phenotypic drug susceptibility testing (DST) was available in 36 (77%) ART programs, but was only used for 22% of all TB patients. Molecular DST was available in 33 (70%) programs and was used in 23% of all TB patients. Twenty ART programs (43%) provided directly observed therapy (DOT) during the entire course of treatment, 16 (34%) during the intensive phase only, and 11 (23%) did not follow DOT. Fourteen (30%) ART programs reported no access to second-line anti-tuberculosis regimens; 18 (38%) reported TB drug shortages.

CONCLUSIONS: Capacity to diagnose and treat drug-resistant TB was limited across ART programs in lower-income countries. DOT was not always implemented and drug supplies were regularly interrupted, which may contribute to the global emergence of drug resistance.

TidsskriftInternational Journal of Tuberculosis and Lung Disease
Udgave nummer11
Sider (fra-til)1327-36
StatusUdgivet - nov. 2014



  • Adult
  • Africa
  • Anti-HIV Agents
  • Antitubercular Agents
  • Asia
  • Developing Countries
  • Directly Observed Therapy
  • Female
  • HIV Infections
  • Humans
  • Latin America
  • Male
  • Microbial Sensitivity Tests
  • Questionnaires
  • Tuberculosis, Multidrug-Resistant


Ballif, M., Nhandu, V., Wood, R., Dusingize, J. C., Carter, E. J., Cortes, C. P., McGowan, C. C., Diero, L., Graber, C., Renner, L., Hawerlander, D., Kiertiburanakul, S., Du, Q. T., Sterling, T. R., Egger, M., Fenner, L., International epidemiological Databases to Evaluate AIDS (IeDEA), & Sodemann, M. (2014). Detection and management of drug-resistant tuberculosis in HIV-infected patients in lower-income countries. International Journal of Tuberculosis and Lung Disease, 18(11), 1327-36.