Trends in drug-resistant tuberculosis in a gold-mining workforce in South Africa, 2002–2008
DESIGN: TB programme data analysis.
RESULTS: TB case notification rates decreased between 2002 and 2008 from 4006 to 3018 per 100 000 and from 3192 to 2468/100 000 for Companies A and B, respectively. Human immunodeficiency virus (HIV) prevalence exceeded 80% in TB episodes with known status. The proportion of TB episodes with multidrug-resistant TB (MDR-TB) increased from 6/129 (4.7%) to 17/85 (20.0%) among previously treated cases, and from 4/38 (10.4%) to 7/28 (25.0%) in Companies A and B, respectively (tests for trend, Company A, P < 0.001; Company B, P = 0.304). Case notifications of MDR-TB increased during 2002–2008 from 39.8 to 122.9/100 000/year in Company A and from 7.8 to 96.8/100 000/year in Company B. Coverage of second-line drug susceptibility testing (DST) among MDR-TB episodes was low. Previous treatment exposure was a strong risk factor for MDR-TB (prevalence ratio 8.78, 95%CI 5.94–12.97 in previously treated vs. untreated individuals).
CONCLUSION: Despite decreasing TB notifications overall, MDR-TB notifications and proportions of episodes with MDR-TB increased in the larger company. Cure must be ensured in first episodes to prevent acquired resistance. Improved coverage of culture, DST and HIV testing is required to allow treatment to be optimised.
Keywords: HIV; drug susceptibility testing; isoniazid; multidrug resistance; rifampicin
Document Type: Research Article
Affiliations: 1: London School of Hygiene & Tropical Medicine, London, UK 2: The Aurum Institute, Johannesburg, South Africa 3: London School of Hygiene & Tropical Medicine, London, UK; The Aurum Institute, Johannesburg, South Africa; Centre for AIDS Programme of Research, University of KwaZulu-Natal, Durban, South Africa
Publication date: 01 July 2012
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