Impact of Infection Control Measures to Control an Outbreak of Multidrug-Resistant Tuberculosis in a Human Immunodeficiency Virus Ward, Peru.
Multidrug-resistant tuberculosis (MDRTB) rates in a human immunodeficiency virus (HIV) care facility increased by the year 2000-56% of TB cases, eight times the national MDRTB rate. We reported the effect of tuberculosis infection control measures that were introduced in 2001 and that consisted of 1) building a respiratory isolation ward with mechanical ventilation, 2) triage segregation of patients, 3) relocation of waiting room to outdoors, 4) rapid sputum smear microscopy, and 5) culture/drug-susceptibility testing with the microscopic-observation drug-susceptibility assay. Records pertaining to patients attending the study site between 1997 and 2004 were reviewed. Six hundred and fifty five HIV/TB-coinfected patients (mean age 33 years, 79% male) who attended the service during the study period were included. After the intervention, MDRTB rates declined to 20% of TB cases by the year 2004 (P = 0.01). Extremely limited access to antiretroviral therapy and specific MDRTB therapy did not change during this period, and concurrently, national MDRTB prevalence increased, implying that the infection control measures caused the fall in MDRTB rates. The infection control measures were estimated to have cost US$91,031 while preventing 97 MDRTB cases, potentially saving US$1,430,026. Thus, this intervention significantly reduced MDRTB within an HIV care facility in this resource-constrained setting and should be cost-effective.
Department of Infectious Diseases, Hospital Nacional Dos de Mayo, Lima, Peru.|Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru.
Eduardo
E
Ticona
Department of Microbiology, Hospital Nacional Dos De Mayo, Lima, Peru.|Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru.
Luz
L
Huaroto
Department of Infectious Diseases and Immunity, Imperial College London, London, United Kingdom.|Department of Medical Microbiology, St George's Hospital, London, United Kingdom.
Daniela E
DE
Kirwan
Department of Infectious Diseases, Hospital Nacional Dos de Mayo, Lima, Peru.
Milagros
M
Chumpitaz
Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
César V
CV
Munayco
Asociacion Benéfica Proyectos en Informatica, Salud, Medicina, y Agricultura (PRISMA), Lima, Peru.
Mónica
M
Maguiña
Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru.
Marco A
MA
Tovar
Wellcome Trust Centre for Global Health Research, Imperial College London, London, United Kingdom.|Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru.|Department of Infectious Diseases and Immunity, Imperial College London, London, United Kingdom.
Carlton A
CA
Evans
Wellcome Trust Centre for Global Health Research, Imperial College London, London, United Kingdom.|Department of Infectious Diseases and Immunity, Imperial College London, London, United Kingdom.
Roderick
R
Escombe
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.|Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru.|Asociacion Benéfica Proyectos en Informatica, Salud, Medicina, y Agricultura (PRISMA), Lima, Peru.
Robert H
RH
Gilman
D000995:Antitubercular Agents / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D024901:Drug Resistance, Multiple, Bacterial; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D017721:Hospital Costs; D006801:Humans; D017053:Infection Control / Q000191:economics / Q000379:methods*; D010356:Patient Isolation; D010568:Peru / Q000453:epidemiology; D012189:Retrospective Studies; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology* / Q000517:prevention & control*
D000995:Antitubercular Agents