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 US91,031 while preventing 97 MDRTB cases, potentially saving US1,430,026. Thus, this intervention significantly reduced MDRTB within an HIV care facility in this resourceconstrained setting and should be cost-effective.
Bibliographical noteFunding Information:
Financial support: We acknowledge financial support from the Wellcome Trust (awards 057434/Z/99/Z, 070005/Z/02/Z, 078340/Z/05/Z, 105788/Z/14/Z, and 201251/Z/16/Z), the Joint Global Health Trials consortium (award MR/K007467/1), the charity IFHAD: Innovation For Health And Development; DFID-CSCF, the Bill & Melinda Gates Foundation (award OPP1118545), the World Aids Fund, the Sir Halley Stewart Trust, the National Institute for Health Research, and the Imperial College Biomedical Research Centre.
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