Multidrug-resistant tuberculosis outbreak associated with poor treatment adherence and delayed treatment: Arua District, Uganda, 2013–2017

Details

• Alternative Title:
  BMC Infect Dis
• Personal Author:
  Okethwangu, Denis ; Birungi, Doreen ; Biribawa, Claire ; Kwesiga, Benon ; Turyahabwe, Stavia ; Ario, Alex R. ; Zhu, Bao-Ping
• Description:
  Background
  
  In August 2017, the Uganda Ministry of Health was notified of increased cases of multidrug-resistant tuberculosis (MDR-TB) in Arua District, Uganda during 2017. We investigated to identify the scope of the increase and risk factors for infection, evaluate health facilities’ capacity to manage MDR-TB, and recommend evidence-based control measures.
  
  Methods
  
  We defined an MDR-TB case-patient as a TB patient attending Arua Regional Referral Hospital (ARRH) during 2013–2017 with a sputum sample yielding Mycobacterium tuberculosis resistant to at least rifampicin and isoniazid, confirmed by an approved drug susceptibility test. We reviewed clinical records from ARRH and compared the number of MDR-TB cases during January–August 2017 with the same months in 2013–2016. To identify risk factors specific for MDR-TB among cases with secondary infection, we conducted a case-control study using persons with drug-susceptible TB matched by sub-county of residence as controls. We observed infection prevention and control practices in health facilities and community, and assessed health facilities’ capacity to manage TB.
  
  Results
  
  We identified 33 patients with MDR-TB, of whom 30 were secondary TB infection cases. The number of cases during January–August 2017 was 10, compared with 3–4 cases in January–August from 2013 to 2016 (p = 0.02). Men were more affected than women (6.5 vs 1.6/100,000, p < 0.01), as were cases ≥18 years old compared to those < 18 years (8.7 vs 0.21/100,000, p < 0.01). In the case-control study, poor adherence to first-line anti-TB treatment (aOR = 9.2, 95% CI: 2.3–37) and initiating treatment > 15 months from symptom onset (aOR = 11, 95% CI: 1.5–87) were associated with MDR-TB. All ten facilities assessed reported stockouts of TB commodities. All 15 ambulatory MDR-TB patients we observed were not wearing masks given to them to minimize community infection. The MDR-TB ward at ARRH capacity was 4 patients but there were 11 patients.
  
  Conclusion
  
  The number of cases during January–August in 2017 was significantly higher than during the same months in 2013–2016. Poor adherence to TB drugs and delayed treatment initiation were associated with MDR-TB infection. We recommended strengthening directly-observed treatment strategy, increasing access to treatment services, and increasing the number of beds in the MDR-TB ward at ARRH.
  
  
• Subjects:
  Adolescent Adult Aged Antitubercular Agents Case-Control Studies Child Disease Outbreaks Female Global Health Security Humans Isoniazid Male Middle Aged Multidrug-resistant Tuberculosis Mycobacterium Tuberculosis Odds Ratio Research Article Rifampicin Risk Factors Treatment Adherence And Compliance Tuberculosis, Multidrug-Resistant Uganda Young Adult

  More +
• Source:
  BMC Infect Dis. 19
• Pubmed ID:
  31064332
• Pubmed Central ID:
  PMC6503550
• Document Type:
  Journal Article
• Funding:
  GH001353-01/U.S. President's Emergency Plan for AIDS Relief/
• Volume:
  19
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:cfacd724f3b690475387f965f0946c3558f900db53776aa9eeb47a2af04e5674
• Download URL:
  https://stacks.cdc.gov/view/cdc/78632/cdc_78632_DS1.pdf
• File Type:
  [PDF - 988.49 KB ]