title: Prevalence of drug resistant TB among outpatients at an HIV/TB clinic in Lilongwe, Malawi.
abstract: BACKGROUND
  We sought to determine the prevalence of drug resistant TB among outpatients initiating TB treatment in Lilongwe, Malawi.
  
  
  METHODS
  This was a prospective cohort study of patients 18 years and older initiating TB treatment at Martin Preuss Centre, the primary integrated HIV/TB clinic in Lilongwe, Malawi, from April 2011 to July 2012. Procedures included questionnaires, physical exam, chest x-ray, full blood count and sputum collection. Sputum samples underwent acid-fast bacilli (AFB) smear testing and culture by Lowenstein-Jensen (LJ) and liquid Mycobacteria Growth Indicator Tube (MGIT) methods. Drug sensitivity was investigated using the Hain GenoType MTBDRplus line probe assay.
  
  
  RESULTS
  Of the 702 patients, 219 (31.2%) were female and 653 (93.0%) were presenting for first-time TB treatment. HIV co-infection was present in 420 (59.8%) cases, with 137 (32.6%) of those patients receiving antiretroviral therapy at presentation. TB was culture-confirmed in 375 (53.4%) patients, 349 of which were first time treatment and 26 retreatment. Ten cases of isoniazid-resistant TB (2.9% of culture confirmed cases of newly treated TB), one of rifampin-resistant TB (0.3% culture confirmed cases of newly treated TB) and one of multi-drug resistant TB (MDR-TB) (3.8% of culture confirmed cases of retreatment TB) were detected.
  
  
  CONCLUSIONS
  MDR-TB prevalence is low among outpatients initiating TB treatment in Lilongwe.
authors.affiliation: University of North Carolina Project, Lilongwe, Malawi Vanderbilt University School of Medicine, Nashville, Tennessee, United States bbarnett@partners.org.
authors.forename: Brian
authors.initials: B
authors.lastname: Barnett
authors.affiliation: University of North Carolina Project, Lilongwe, Malawi.
authors.forename: Runa H
authors.initials: RH
authors.lastname: Gokhale
authors.affiliation: University of North Carolina Project, Lilongwe, Malawi.
authors.forename: Robert
authors.initials: R
authors.lastname: Krysiak
authors.affiliation: University of North Carolina Project, Lilongwe, Malawi.
authors.forename: Creto
authors.initials: C
authors.lastname: Kanyemba
authors.affiliation: University of North Carolina Project, Lilongwe, Malawi.
authors.forename: Tarsizio
authors.initials: T
authors.lastname: Chikaonda
authors.affiliation: Light House Clinic Trust, Lilongwe, Malawi.
authors.forename: Mphatso
authors.initials: M
authors.lastname: Bokosi
authors.affiliation: University of North Carolina Project, Lilongwe, Malawi.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Mukuzunga
authors.affiliation: University of North Carolina Project, Lilongwe, Malawi.
authors.forename: Friday
authors.initials: F
authors.lastname: Saidi
authors.affiliation: Light House Clinic Trust, Lilongwe, Malawi.
authors.forename: Sam
authors.initials: S
authors.lastname: Phiri
authors.affiliation: Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.
authors.forename: Irving F
authors.initials: IF
authors.lastname: Hoffman
authors.affiliation: University of North Carolina Project, Lilongwe, Malawi Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000494:pharmacology / Q000627:therapeutic use; D060085:Coinfection / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D007538:Isoniazid / Q000494:pharmacology / Q000627:therapeutic use; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D015995:Prevalence; D011446:Prospective Studies; D012293:Rifampin / Q000494:pharmacology / Q000627:therapeutic use; D013183:Sputum / Q000382:microbiology; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid; D012293:Rifampin
keywords: Africa South of the Sahara; Epidemiology; Isoniazid; Multi-drug resistant; Rifampin; Tuberculosis