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4 th National Anti-tuberculosis Drug Resistance Survey Botswana, 2007

4 th National Anti-tuberculosis Drug Resistance Survey Botswana, 2007 . Objectives. Perform drug resistance survey among culture positive TB patients Identify trends of 1 st -line drug resistance compared to previous surveys Perform 2 nd line drug testing to identify XDR-TB

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4 th National Anti-tuberculosis Drug Resistance Survey Botswana, 2007

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  1. 4th National Anti-tuberculosis Drug Resistance SurveyBotswana, 2007

  2. Objectives • Perform drug resistance survey among culture positive TB patients • Identify trends of 1st-line drug resistance compared to previous surveys • Perform 2nd line drug testing to identify XDR-TB • Determine prevalence of HIV infection among TB patients • Evaluate whether HIV infection is a risk factor for MDR TB

  3. Background • Multidrug-resistant TB (MDR TB) • Resistance to at least isoniazid and rifampin • Extensively drug-resistant TB (XDR TB) • MDR TB plus resistance to: • a fluoroquinolone AND • one or more injectable 2nd line drug (amikacin, capreomycin, kanamycin)

  4. Background (3) • Concern for increasing anti-TB drug resistance • Previous 3 national drug resistance surveys of NEW cases: • 1995/96: 3.7% any resistance/ 0.2% MDR TB • 1999: 6.3% any resistance/ 0.5% MDR TB • 2002: 10.4% any resistance/ 0.8% MDR TB • XDR TB recently identified in South Africa • High HIV prevalence • 2005: 33.4% of women receiving antenatal testing are HIV+ in Botswana

  5. Methods • May – October 2007 To NTRL • All sputum specimens from NEW smear-positive cases • All retreatment cases • Culture on Lowenstein Jensen media • 1st line drug susceptibility testing at NTRL • 2nd line drug susceptibility testing at SNRL in South Africa • Participating sites: all facilities offering TB treatment (inpatient and outpatient)

  6. HIV Testing • To determine HIV prevalence: • Unlinked anonymous HIV testing of all sputum specimens using Oraquick • Unique ID (UID) assigned by 3rd party algorithm • To evaluate HIV as risk factor for MDR TB • De-identified DST results assigned same UID by 3rd party algorithm and merged with unlinked anonymous HIV results

  7. Expected Results • Primary • Identify trends in resistance to anti-TB drugs • Secondary • Identify trends in MDR TB • Identify XDR TB and establish baseline for analysis of future trends • Determine HIV prevalence among TB patients • Determine if HIV infection is risk factor for MDR-TB • Identify trends in rifampin mono-resistance • Determine rates of high-level and low-level isoniazid resistance

  8. TBC Role • To assist with and facilitate the survey by • Follow-up calls to clinics and labs to be sure they are submitting specimens in a timely fashion • Working with survey coordinator at the NTRL to be sure that the proper number of specimens are received • Working with NTRL to follow-up on missing data • Work with NTRL and Clinic Matrons to ensure that

  9. Next Steps • Study Investigators will develop SOPs (standard operating procedures) for study • Investigators will visit each district to train for study in April and May • Data collection to commence in May

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