Nontuberculous mycobacteria pulmonary disease and tuberculosis-nontuberculous mycobacteria co-infection: Epidemiology, diagnosis, and management at a tertiary health facility in Ghana

Nontuberculous mycobacterial pulmonary disease (NTM-PD) is increasing worldwide, with annual prevalence rates in Europe estimated to be 6.2/100,000 in 2016. Risk factors for NTM-PD include bronchiectasis and previous tuberculosis (TB). To date, the prevalence, risk factors and treatment outcomes are not well characterised in Sub-Saharan Africa (SSA). However, it is known from other settings that NTM-PD can be associated with high mortality, a significant financial burden and often unfavourable treatment outcomes. Additionally, recent study data illustrated that NTM-infected patients had a poor prognosis compared to TB patients or the general population, especially patients with TB/NTM co-infection. Therefore, this study aims to understand the epidemiology and evaluate the diagnosis and management of patients with NTM-PD and TB/NTM co-infection in this setting.

This research will evaluate the prevalence of NTM isolates and NTM-PD in presumed TB cases and the NTM species that predominate ('colonisation' and disease) in our setting. In addition, the treatment outcomes for presumed/diagnosed TB patients with and without NTM will be studied, indicating whether a treatment change would be recommended. Furthermore, the prevalence and predictors of NTM isolation among patients who have undergone treatment for rifampicin-resistant/multidrug-resistant TB (RR/MDR-TB) using the short-course treatment will be evaluated. All clinical studies will take place in a tertiary facility, the Cape Coast Teaching Hospital (CCTH), Ghana

The project will entail four studies: 1) a scoping review to assess the current knowledge gaps in NTM-PD and TB/NTM co-infection in SSA; 2) A retrospective analysis of cultures of pulmonary samples of all presumed/documented DR-TB patients who have had a culture done; 3) a retrospective cohort study looking at the frequency of NTM colonisation at the start and during treatment in DR-TB patients who underwent short-course chemotherapy with injectable-based regimen versus all oral DR-TB regimen 4) a prospective cohort study on NTM prevalence and species identification, as well as the management and outcome of NTM-infected patients with or without TB diagnosis. A combination of descriptive and analytical statistics will be used. REDCap and Excel will be used for data capturing. The project will run from January 2022 – December 2025.

This work will help understand the extent and impact of NTM-PD and TB/NTM co-infection in SSA in presumed and confirmed TB patients. Additionally, it will be useful to evaluate current treatment approaches of NTM-PD and TB/NTM co-infection and offer insight into whether the current management needs to be adapted. Moreover, study findings will be utilised to propose an algorithm for clinicians and policymakers for the management of NTM-PD and TB/NTM co-infection. Eventually, NTM isolates will be deposited in the Belgian Coordinated Collections of Microorganisms to increase the availability of NTM isolates from SSA for researchers from all over the world.