title: Detection and management of drug-resistant tuberculosis in HIV-infected patients in lower-income countries.
abstract: METHODS
  Drug resistance threatens tuberculosis (TB) control, particularly among human immunodeficiency virus (HIV) infected persons.
  
  
  OBJECTIVE
  To describe practices in the prevention and management of drug-resistant TB under antiretroviral therapy (ART) programs in lower-income countries.
  
  
  METHODS
  We used online questionnaires to collect program-level data on 47 ART programs in Southern Africa (n = 14), East Africa (n = 8), West Africa (n = 7), Central Africa (n = 5), Latin America (n = 7) and the Asia-Pacific (n = 6 programs) in 2012. Patient-level data were collected on 1002 adult TB patients seen at 40 of the participating ART programs.
  
  
  RESULTS
  Phenotypic drug susceptibility testing (DST) was available in 36 (77%) ART programs, but was only used for 22% of all TB patients. Molecular DST was available in 33 (70%) programs and was used in 23% of all TB patients. Twenty ART programs (43%) provided directly observed therapy (DOT) during the entire course of treatment, 16 (34%) during the intensive phase only, and 11 (23%) did not follow DOT. Fourteen (30%) ART programs reported no access to second-line anti-tuberculosis 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 supplies were regularly interrupted, which may contribute to the global emergence of drug resistance.
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Ballif
authors.affiliation: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors.forename: V
authors.initials: V
authors.lastname: Nhandu
authors.affiliation: Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
authors.forename: R
authors.initials: R
authors.lastname: Wood
authors.affiliation: Women's Equity in Access to Care & Treatment, Kigali, Rwanda.
authors.forename: J C
authors.initials: JC
authors.lastname: Dusingize
authors.affiliation: United States Agency for International Development Academic Model Providing Access to Healthcare, Eldoret, Kenya.
authors.forename: E J
authors.initials: EJ
authors.lastname: Carter
authors.affiliation: University of Chile School of Medicine, Santiago, Chile.
authors.forename: C P
authors.initials: CP
authors.lastname: Cortes
authors.affiliation: Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: C C
authors.initials: CC
authors.lastname: McGowan
authors.affiliation: United States Agency for International Development Academic Model Providing Access to Healthcare, Eldoret, Kenya.
authors.forename: L
authors.initials: L
authors.lastname: Diero
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Graber
authors.affiliation: University of Ghana Medical School, Accra, Ghana.
authors.forename: L
authors.initials: L
authors.lastname: Renner
authors.affiliation: Centre Intégré de Recherches Biocliniques, Abidjan, Côte d'Ivoire.
authors.forename: D
authors.initials: D
authors.lastname: Hawerlander
authors.affiliation: Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Children's Hospital, Ho Chi Minh City, Viet Nam.
authors.forename: S
authors.initials: S
authors.lastname: Kiertiburanakul
authors.affiliation: Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland.
authors.forename: Q T
authors.initials: QT
authors.lastname: Du
authors.affiliation: Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: T R
authors.initials: TR
authors.lastname: Sterling
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Egger
authors.affiliation: Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland.
authors.forename: L
authors.initials: L
authors.lastname: Fenner
mesh_terms: D000328:Adult; D000349:Africa / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000600:supply & distribution / Q000627:therapeutic use*; D001208:Asia / Q000453:epidemiology; D003906:Developing Countries; D023801:Directly Observed Therapy; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D011795:Surveys and Questionnaires; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents