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The Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa Global and Local Challenges and Solutions: Summary of a Joint Workshop by the Institute of Medicine and the Academy of Science of South Africa (2011) / Chapter Skim
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2 The Incidence of Drug-Resistant TB in Southern Africa
Pages 9-20

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From page 9...
... • An outbreak of XDR TB in Tugela Ferry, KwaZulu-Natal Province, South Africa, reported in 2006, raised great concern about transmis sion in health care, community, and household settings. • Since 2006, cases of XDR TB have occurred in all provinces of South Africa and in all surrounding countries.
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From page 10...
... . By WHO estimates, 440,000 global cases of MDR TB arose in 2008; about 5.4 percent of these cases were XDR TB.
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From page 11...
... The data suggest that the more new cases of TB are diagnosed by cultured specimens in a health district, the higher is the percentage of drug-resistant TB found in that district.2 In addition, the districts with the highest rates of MDR and XDR TB are those that house or have a strong link with academic centers, which send greater numbers of specimens for culture relative to other facilities. For every patient who is diagnosed with and treated for MDR TB in southern Africa, it is likely that several more are diagnosed and not treated.
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From page 12...
... MDR AND XDR TB IN SOUTH AFRICA According to several workshop presenters, drug-resistant TB imposes a tremendous health burden throughout southern Africa. Tomás Zimba of Mozambique's Maputo Central Hospital described efforts to control and treat MDR TB patients in the country.
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From page 13...
... . According to Zimba, however, it is known that the Mozambique national TB program has in the past seriously under estimated the numbers of new cases of MDR TB.
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From page 14...
... MDR TB patients in South Africa are three times more likely than their counterparts from other PETTS sites/ countries to have cross-resistance to all the injectable drugs for TB at baseline. The PETTS study has shown that XDR TB was present at baseline in 10.3 percent of cases in 2005 (Kvasnovsky et al., 2009)
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From page 15...
... . Causes of deaths classified as MDR TB and XDR TB have been included in the South African death notification system only since 2006.
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From page 16...
... In addition, every province in South Africa and all neighboring countries have reported cases of XDR TB. MDR TB has undergone a similarly dramatic increase in KwaZuluNatal Province.
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From page 17...
... The outbreak of XDR TB in the province therefore raised the question of whether the 2001−2002 data underrepresented the extent of MDR TB infection. The study reported by Gandhi, which received international attention, found that XDR TB in that population was highly fatal.
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From page 18...
... MDR TB patients with resistance to only isoniazid and rifampicin do better than those with additional firstline drug resistance. Likewise, XDR TB patients with resistance to only four or five drugs do better than those with resistance to all six drugs tested.
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From page 19...
... in South Africa have been up to 20 percent of patients on second-line anti-TB treatment, with no difference between HIV-positive and HIV-negative groups. A retrospective study of 2,070 patients on standardized MDR TB treatment in nine provinces of South Africa between 2000 and 2004 revealed that patients coinfected with HIV were three times more likely to die than patients without HIV (van der Walt et al., 2007)
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From page 20...
... 20 DRUG-RESISTANT TUBERCULOSIS IN SOUTHERN AFRICA Looking at South Africa in particular, Chaisson noted that it has made remarkable progress in extending antiretroviral therapy among its population. The current challenge is to meet the global standard of care for providing antiretroviral therapy to TB patients coinfected with HIV, as it has been shown that survival is dramatically improved when antiretrovirals are given during rather than after TB therapy (Abdool Karim et al., 2010)
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Key Terms

  • south africa
  • tugela ferry
  • van der
  • der walt
  • drug susceptibility

  • hiv epidemic
  • susceptibility testing
  • africa according
  • six drugs
  • death notification

  • msinga subdistrict
  • patients coinfected
  • neel gandhi
  • drugs tested
  • notification forms

  • ferry care
  • natal province
  • hiv infection
  • drug resistance
  • chaisson noted

  • antiretroviral therapy
  • median survival
  • underlying cause
  • diverse mdr
  • standardized mdr

  • treat mdr
  • suspected mdr
  • primary mdr
  • throughout southern
  • south african


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