title: Antituberculosis Drug Resistance Survey in Lesotho, 2008-2009: Lessons Learned.
abstract: METHODS
  Drug resistance is an increasing threat to tuberculosis (TB) control worldwide. The World Health Organization advises monitoring for drug resistance, with either ongoing surveillance or periodic surveys.
  
  
  METHODS
  The antituberculosis drug resistance survey was conducted in Lesotho in 2008-2009. Basic demographic and TB history information was collected from individuals with positive sputum smear results at 17 diagnostic facilities. Additional sputum sample was sent to the national TB reference laboratory for culture and drug susceptibility testing.
  
  
  RESULTS
  Among 3441 eligible smear-positive persons, 1121 (32.6%) were not requested to submit sputum for culture. Among 2320 persons submitted sputum, 1164 (50.2%) were not asked for clinical information or did not have valid sputum samples for testing. In addition, 445/2320 (19.2%) were excluded from analysis because of other laboratory or data management reasons. Among 984/3441 (28.6%) persons who had data available for analysis, MDR-TB was present in 24/773 (3.1%) of new and 25/195 (12.8%) of retreatment TB cases. Logistical, operational and data management challenges affected survey results.
  
  
  CONCLUSIONS
  MDR-TB is prevalent in Lesotho, but limitations reduced the reliability of our findings. Multiple lessons learned during this survey can be applied to improve the next drug resistance survey in Lesotho and other resource constrained countries may learn how to avoid these bottlenecks.
authors.affiliation: National TB Programme, Ministry of Health, Maseru, Lesotho.
authors.forename: Llang B
authors.initials: LB
authors.lastname: Maama-Maime
authors.affiliation: Laboratory Services, Ministry of Health, Maseru, Lesotho.
authors.forename: Mathabo
authors.initials: M
authors.lastname: Mareka
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, United States of America.
authors.forename: Julia V
authors.initials: JV
authors.lastname: Ershova
authors.affiliation: Laboratory Services, Ministry of Health, Maseru, Lesotho.
authors.forename: Thabong E
authors.initials: TE
authors.lastname: Tlali
authors.affiliation: Laboratory Services, Ministry of Health, Maseru, Lesotho.
authors.forename: Kekeletso
authors.initials: K
authors.lastname: Kao
authors.affiliation: Laboratory Services, Ministry of Health, Maseru, Lesotho.
authors.forename: Mamakhetha
authors.initials: M
authors.lastname: Phalatse
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, United States of America.
authors.forename: Lauren
authors.initials: L
authors.lastname: Polansky
authors.affiliation: Emory University, Atlanta, United States of America.
authors.forename: Laura K
authors.initials: LK
authors.lastname: Beres
authors.affiliation: Disease Control, Ministry of Health, Maseru, Lesotho.
authors.forename: Moselinyane
authors.initials: M
authors.lastname: Letsie
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, United States of America.
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Holtz
mesh_terms: D000995:Antitubercular Agents / Q000494:pharmacology* / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005843:Geography; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D013019:South Africa / Q000453:epidemiology; D013183:Sputum / Q000382:microbiology; D011795:Surveys and Questionnaires; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology* / Q000382:microbiology*
chemical_list: D000995:Antitubercular Agents