SEATTLE, WA — The majority of extensively drug resistant tuberculosis cases in South Africa are due to transmission in this high HIV prevalence setting, and not the result of inadequate treatment, study results presented here today showed. Sarita Shah from the U.S. Centers for Disease Control and Prevention shared the results and noted South Africa has experienced a five-fold increase in XDR-TB with 298 cases in 2005 and 1545 cases in 2012. More than 70 percent of these cases occur in patients with HIV infection.
The study was conducted in KwaZulu Natal South Africa — home to half the country’s XDR-TB cases and to 1.6 million people with HIV — to determine the proportion of XDR-TB cases due to inadequate treatment versus the proportion of cases due to transmission of drug-resistant disease. The study enrolled 404 individuals, the majority of whom lived in Durban or the Tugela Ferry area where XDR-TB was first identified. Interviews and medical record reviews determined that 21 percent of the patients had prior treatment for drug-resistant tuberculosis. This categorized their XDR tuberculosis as acquired. The other 79 percent of the patients were infected with XDR-TB through direct transmission from others in healthcare or community settings. About half of the patients had been hospitalized during the last five years.
Shah suggested that the implications of these findings called for prevention efforts to focus on infection control, including redesigning healthcare facilities to improve the capacity to isolate patients and redesigning settings where people gather to improve ventilation. She identified universal access to tuberculosis drug susceptibility testing and earlier access to treatment as “urgent needs.”