EXTENSIVELY DRUG-RESISTANT TUBERCULOSIS: THE ROLE OF PRIMARY TRANSMISSION IN KWAZULU NATAL, SOUTH AFRICA Público

Feldpausch, Amanda (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/08612p16p?locale=es
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Abstract

Background

Extensively drug-resistant tuberculosis (XDR TB) remains a major health concern in KwaZulu Natal, South Africa. With high rates of HIV co-infection and poor clinical outcomes, prevention of XDR TB cases is imperative. Current prevention programs assume drug resistance is most often acquired as a result of incomplete or improper therapy; however, little is known of the impact of primary transmission on the epidemic. In order to inform effective intervention programs, we examined genotypic and epidemiologic data to determine the mechanism of development of XDR TB in the province.

Methods

We investigated culture-confirmed XDR TB cases diagnosed in KwaZulu-Natal province between August 2011 and April 2012. Data were collected from each enrolled case through a patient interview, medical record review, home visit, and genotyping of the XDR TB isolate. XDR TB cases were considered to be due to acquired resistance if there was evidence of previous treatment for MDR TB. Data from genotyping and epidemiologic investigation were used to transmission links between enrolled patients.

Results

A total of 140 XDR TB patients were screened for inclusion in the study from August 2011 to April 2012, of which. 107 patients were enrolled. XDR TB isolates were available were transported to our lab for 73 of these patients and 66 patients had genotyping data available to be included in the analysis. The median age was 35 years (IQR 28-45) and 36 (55%) were female; 50 (76%) patients were HIV-infected. Only 23 (35%) had history of prior MDR TB treatment. Additionally, XDR TB isolates from 58 (88%) of the 66 patients studied were genetically similar and determined to be clustered. Epidemiologic links were found between 20 (34%) of patients and other patients within their own cluster through residential information and places of social congregation. After review of all data, 62 (94%) of patients were considered to have resistance as a result of primary transmission.

Conclusions

Primary transmission appears to be the mechanism by which the majority of individuals develop XDR TB in KwaZulu-Natal. Further characterization of the transmission networks in the province may help define the focus of effective intervention programs.

Table of Contents

Table of Contents


CHAPTER I: BACKGROUND .......................................................................................... 1

CHAPTER II: MANUSCRIPT ......................................................................................... 20

Introduction ................................................................................................................... 21
Methods ......................................................................................................................... 23
Results ........................................................................................................................... 28
Discussion ..................................................................................................................... 30

REFERENCES ................................................................................................................. 35

TABLES ........................................................................................................................... 43

FIGURES .......................................................................................................................... 46

CHAPTER III: SUMMARY, PUBLIC HEALTH IMPLICATIONS, FUTURE DIRECTIONS ................................................................................................................... 47

APPENDICES .................................................................................................................. 49
APPENDIX I: ADDITIONAL TABLES AND FIGURES .......................................... 49
APPENDIX II: DATA COLLECTION FORMS.......................................................... 50
APPENDIX III: ETHICAL APPROVAL ..................................................................... 58

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