title: Increase in anti-tuberculosis drug resistance in Botswana: results from the fourth National Drug Resistance Survey.
abstract: METHODS
  Although approximately 0.5 million cases of multidrug-resistant tuberculosis (MDR-TB) occur globally each year, surveillance data are limited. Botswana is one of the few high TB burden countries to have carried out multiple anti-tuberculosis drug resistance surveys (in 1995-1996, 1999 and 2002).
  
  
  OBJECTIVE
  In 2007-2008, we conducted the fourth national survey of anti-tuberculosis drug resistance in Botswana to assess anti-tuberculosis drug resistance, including trends over time. In the previous survey, 0.8% (95%CI 0.4-1.5) of new patients and 10.4% (95%CI 5.6-17.3) of previously treated patients had MDR-TB.
  
  
  METHODS
  During the survey period, eligible specimens from all new sputum-smear positive TB patients and from all TB patients with history of previous anti-tuberculosis treatment underwent mycobacterial culture and anti-tuberculosis drug susceptibility testing (DST).
  
  
  RESULTS
  Of 924 new TB patients and 137 with previous anti-tuberculosis treatment with DST results, respectively 23 (2.5%, 95%CI 1.6-3.7) and 9 (6.6%, 95%CI 3.3-11.7) had MDR-TB. The proportion of new TB patients with MDR-TB has tripled in Botswana since the previous survey.
  
  
  CONCLUSIONS
  Combatting drug-resistant TB will require the scale-up of MDR-TB diagnosis and treatment to prevent the transmission of MDR-TB and strengthening of general TB control to prevent the emergence of resistance.
authors.affiliation: US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
authors.forename: H J
authors.initials: HJ
authors.lastname: Menzies
authors.affiliation: Botswana National Tuberculosis Program, Gaborone, Botswana.
authors.forename: G
authors.initials: G
authors.lastname: Moalosi
authors.affiliation: Association of Public Health Laboratories, Silver Spring, Maryland, USA.
authors.forename: V
authors.initials: V
authors.lastname: Anisimova
authors.affiliation: US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
authors.forename: V
authors.initials: V
authors.lastname: Gammino
authors.affiliation: Botswana National Tuberculosis Program, Gaborone, Botswana.
authors.forename: C
authors.initials: C
authors.lastname: Sentle
authors.affiliation: CDC Botswana, Gaborone, Botswana.
authors.forename: M A
authors.initials: MA
authors.lastname: Bachhuber
authors.affiliation: US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
authors.forename: E
authors.initials: E
authors.lastname: Bile
authors.affiliation: Botswana National Tuberculosis Reference Laboratory, Gaborone, Botswana.
authors.forename: K
authors.initials: K
authors.lastname: Radisowa
authors.affiliation: KNCV Tuberculosis Foundation, The Hague, The Netherlands.
authors.forename: O
authors.initials: O
authors.lastname: Kachuwaire
authors.affiliation: Botswana National Tuberculosis Reference Laboratory, Gaborone, Botswana.
authors.forename: J
authors.initials: J
authors.lastname: Basotli
authors.affiliation: Botswana National Tuberculosis Reference Laboratory, Gaborone, Botswana.
authors.forename: T
authors.initials: T
authors.lastname: Maribe
authors.affiliation: CDC Botswana, Gaborone, Botswana.
authors.forename: R
authors.initials: R
authors.lastname: Makombe
authors.affiliation: CDC Botswana, Gaborone, Botswana.
authors.forename: J
authors.initials: J
authors.lastname: Shepherd
authors.affiliation: US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
authors.forename: B
authors.initials: B
authors.lastname: Kim
authors.affiliation: US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
authors.forename: T
authors.initials: T
authors.lastname: Samandari
authors.affiliation: Botswana Ministry of Health, Gaborone, Botswana.
authors.forename: S
authors.initials: S
authors.lastname: El-Halabi
authors.affiliation: Botswana National Tuberculosis Program, Gaborone, Botswana.
authors.forename: J
authors.initials: J
authors.lastname: Chirenda
authors.affiliation: US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
authors.forename: K P
authors.initials: KP
authors.lastname: Cain
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001902:Botswana / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000302:isolation & purification; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents