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2500-12-31
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- INI - Artigos de Periódicos [3392]
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DETECTION AND MANAGEMENT OF DRUG-RESISTANT TUBERCULOSIS IN HIV-INFECTED PATIENTS IN LOWER-INCOME COUNTRIES
Author
Ballif, Marie
Nhandu, Venerandah
Wood, Robin
Dusingize, Jean Claude
Carter, E. Jane
Cortes, Claudia P.
McGowan, Catherine C.
Diero, Lameck
Graber, Claire
Renner, Lorna
Hawerlander, Denise
Kiertiburanakul, Sasisopin
Tuan Du, Quy
Sterling, Timothy R.
Egger, Matthias
Fenner, Lukas
For the International Epidemiological Databases to Evaluate AIDS (IeDEA)
Nhandu, Venerandah
Wood, Robin
Dusingize, Jean Claude
Carter, E. Jane
Cortes, Claudia P.
McGowan, Catherine C.
Diero, Lameck
Graber, Claire
Renner, Lorna
Hawerlander, Denise
Kiertiburanakul, Sasisopin
Tuan Du, Quy
Sterling, Timothy R.
Egger, Matthias
Fenner, Lukas
For the International Epidemiological Databases to Evaluate AIDS (IeDEA)
Affilliation
Institute of Social and Preventive Medicine, University of Bern, Switzerland
Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
Desmond Tutu HIV Centre, University of Cape Town, South Africa
Women’s Equity in Access to Care & Treatment, Kigali, Rwanda
USAID AMPATH, Eldoret, Kenya
University of Chile School of Medicine, Santiago, Chile
Vanderbilt University School of Medicine, Nashville, Tennessee, USA
USAID AMPATH, Eldoret, Kenya
Institute of Social and Preventive Medicine, University of Bern, Switzerland
University of Ghana Medical School, Accra, Ghana
Centre Intégré de Recherches Biocliniques, Abidjan, Côte d’Ivoire
Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Children’s Hospital, Ho Chi Minh City, Vietnam
Swiss Tropical and Public Health Institute, University of Basel, Switzerland
Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
Desmond Tutu HIV Centre, University of Cape Town, South Africa
Women’s Equity in Access to Care & Treatment, Kigali, Rwanda
USAID AMPATH, Eldoret, Kenya
University of Chile School of Medicine, Santiago, Chile
Vanderbilt University School of Medicine, Nashville, Tennessee, USA
USAID AMPATH, Eldoret, Kenya
Institute of Social and Preventive Medicine, University of Bern, Switzerland
University of Ghana Medical School, Accra, Ghana
Centre Intégré de Recherches Biocliniques, Abidjan, Côte d’Ivoire
Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Children’s Hospital, Ho Chi Minh City, Vietnam
Swiss Tropical and Public Health Institute, University of Basel, Switzerland
Abstract
Setting—Drug resistance threatens tuberculosis (TB) control, particularly among HIV-infected
persons.
Objective—We surveyed antiretroviral therapy (ART) programs from lower-income countries on
prevention and management of drug-resistant TB.
Design—We used online questionnaires to collect program-level data in 47 ART programs in
Southern Africa (14), East Africa (8), West Africa (7), Central Africa (5), Latin America (7) and
Asia-Pacific (6 programs) in 2012. Patient-level data were collected on 1,002 adult TB patients
seen at 40 of the participating ART programs.
Results—Phenotypic drug susceptibility testing was available at 36 (77%) ART programs, but
only used for 22% of all TB patients. Molecular drug resistance testing was available at 33 (70%) programs and used for 23% of all TB patients. Twenty ART programs (43%) provided directly
observed therapy (DOT) during the whole treatment, 16 (34%) during intensive phase only and 11
(23%) did not follow DOT. Fourteen (30%) ART programs reported no access to second-line TB
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 supply was
regularly interrupted, which may contribute to the global emergence of drug resistance.
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