Anti-tuberculosis drug resistance in kampala-Uganda.

Abstract

SETTING: Kampala city, where 8000-10000 TB cases are notified annually, contributing about 20% of the national tuberculosis burden in Uganda. OBJECTIVE: To estimate the prevalence and factors associated with anti-tuberculosis drud resistance in kampala as well as the prevalence of HIV among the sputum smear positive TB patients. METHODS: In a cross-sectional survey including all health care units notifying tuberculosis patients in kampala to national tuberculosis programme, 557 consecutive sputum smear-positive tuberculosis patients underwent drug susceptibility testing (DST) to streptomycin, ethambutol, rifampicin and isoniazed. In addition information was collected on socio demographic characteristics, HIV status of patients and previous treatment for tuberculosis. RESULTS: Of the 557 enrolled participants, 533 had drug susceptibility testing (DST) results including 473 (88.7%) new and 60 (11.3%) who were previously treated on TB. Multi drug resistance (MDR) was found in 12 (2.3%, 95%C1 1-4) and resistance to any drug in 74 (14.9% 95% 11-17.1), Resistant to any of the drugs was more common among the previously treated 17/60 (28.3%; 95%C1 17-40) than among new patients 57/473 (12.1% 95% C1 9-15). Similary the risk of MDR was higher among previously treated patients 7/60 (11.7% 95% CI 4.7-22) than among new patients 5/473 (1.1%, 95% CI 0.34-2.5, odds ratio 2.45, 95% CI 1.4-4.0, p=0.002). Of the 517 patients who had HIV testing, 165 (31.9%) were positive. Neither MDR, (OR 0.7, 95%CI 0.19-2.6) P=0.75 nor any resistance (OR 0.7, 95%ci 0.43-1.3) p=0.2 was associated with HIV status. Primary drug resistance was more common among patients who had worked in a health care. OR 3.5 95% CI, 1.0-12) P=0.045. These results will be disseminated to the district health team of kampala where the study was done, the Uganda ministry of health through the review meetings at the national TB/leprosy programme and makerere university school of public health where the study was approved. Results will be used to guide policy on implementation of a multidrug resistant TB programme and prevention of development and spread of tuberculosis drug resistance in the kampala. CONCLUSION: Anti-tuberculosis drug resistance in kampala is still low and not assosicated with HIV infection, but may be associated with health care exposure.