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Low prevalence of MDR‐TB in Lao PDR: results from the first national anti‐tuberculosis drug resistance survey
Author(s) -
Iem Vibol,
Dean Anna,
Zignol Matteo,
Vongvichit Phouvang,
Inthavong Donekham,
Siphanthong Souvimone,
Sorsavanh Theppouthone,
Kim Sang Jae,
Shin Soyoun,
Sébert Jacques,
Chittamany Phonenaly
Publication year - 2019
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13205
Subject(s) - medicine , sputum , tuberculosis , rifampicin , mycobacterium tuberculosis , drug resistance , pulmonary tuberculosis , pathology , microbiology and biotechnology , biology
Objective To present results of the first national anti‐tuberculosis ( TB ) drug resistance survey conducted in Lao PDR between May 2016 and August 2017 to determine the prevalence of resistance to first‐line anti‐ TB drugs among new and previously treated pulmonary TB cases in the country. Methods Patients with sputum smear‐positive pulmonary TB were enrolled from 42 TB laboratories distributed in 40 clusters throughout the country. Survey sites were selected using probability‐proportional‐to‐size sampling among all diagnostic centres in the country. In addition to smear microscopy, all patients underwent Xpert MTB / RIF testing and those found positive to Mycobacterium tuberculosis underwent sputum culture and drug susceptibility testing using the proportion method on solid Löwenstein–Jensen medium. Results Among 1006 eligible patients, 946 sputum smear‐positive and Xpert MTB / RIF positive ( Mycobacterium tuberculosis detected) patients were included in the survey, comprising 897 new and 49 previously treated TB cases. The prevalence of rifampicin‐resistant TB was 1.2% (95% CI : 0.5–2.0%, n = 11/897) among new cases and 4.1% (95% CI : 0–9.6%, n = 2/49) among previously treated cases. Among the 946 TB cases confirmed by Xpert MTB / RIF , phenotypic drug sensitivity testing was available for 820 (776 new and 44 previously treated). The prevalence of multidrug‐resistant TB ( MDR ‐ TB ) was 0.5% (95% CI : 0–1.0%, n = 4/776) among new cases and 2.3% (95% CI : 0–6.7%, n = 1/44) among previously treated cases. No resistance to second‐line injectable agents nor to fluoroquinolones was detected among MDR ‐ TB patients. Conclusions The first national anti‐ TB drug resistance survey in Lao PDR demonstrated an encouragingly low prevalence of MDR ‐ TB . The results appear lower than previous WHO estimates, and in line with the routine surveillance based on Xpert MTB / RIF testing (conducted among 50% of presumptive TB patients in 2017). The country should continue to expand its Xpert MTB / RIF network and strive to achieve universal drug susceptibility testing.