Transcript 3.1 DRS_Survey overview.ppt

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National Anti-tuberculosis
Drug Resistance Survey
Botswana, 2007
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
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)
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
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)
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
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
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
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