TY - JOUR
T1 - The emerging threat of pre-extensively drug-resistant tuberculosis in West Africa: preparing for large-scale tuberculosis research and drug resistance surveillance
AU - Gehre, Florian
AU - Otu, Jacob
AU - Kendall, Lindsay
AU - Forson, Audrey
AU - Kwara, Awewura
AU - Kudzawu, Samuel
AU - Kehinde, Aderemi O.
AU - Adebiyi, Oludele
AU - Salako, Kayode
AU - Baldeh, Ignatius
AU - Jallow, Aisha
AU - Jallow, Mamadou
AU - Dagnra, Anoumou
AU - Disse, Kodjo
AU - Kadanga, Essosimna A.
AU - Idigbe, Emmanuel Oni
AU - Onubogu, Catherine
AU - Onyejepu, Nneka
AU - Gaye-Diallo, Aissatou
AU - Ba-Diallo, Awa
AU - Rabna, Paulo
AU - Mane, Morto
AU - Sanogo, Moumine
AU - Diarra, Bassirou
AU - Dezemon, Zingue
AU - Sanou, Adama
AU - Senghore, Madikay
AU - Kwambana-Adams, Brenda A.
AU - Demba, Edward
AU - Faal-Jawara, Tutty
AU - Kumar, Samrat
AU - Tientcheu, Leopold D.
AU - Jallow, Adama
AU - Ceesay, Samba
AU - Adetifa, Ifedayo
AU - Jaye, Assan
AU - Pallen, Mark J.
AU - D'Alessandro, Umberto
AU - Kampmann, Beate
AU - Adegbola, Richard A.
AU - Mboup, Souleymane
AU - Corrah, Tumani
AU - de Jong, Bouke C.
AU - Antonio, Martin
N1 - FTX; DOAJ
PY - 2016
Y1 - 2016
N2 - Background: Drug-resistant tuberculosis (TB) is a global public health problem. Adequate management requires baseline drug-resistance prevalence data. In West Africa, due to a poor laboratory infrastructure and inadequate capacity, such data are scarce. Therefore, the true extent of drug-resistant TB was hitherto undetermined. In 2008, a new research network, the West African Network of Excellence for Tuberculosis, AIDS and Malaria (WANETAM), was founded, comprising nine study sites from eight West African countries (Burkina Faso, The Gambia, Ghana, Guinea-Bissau, Mali, Nigeria, Senegal and Togo). The goal was to establish Good Clinical Laboratory Practice (GCLP) principles and build capacity in standardised smear microscopy and mycobacterial culture across partnering laboratories to generate the first comprehensive West African drug-resistance data.Methods: Following GCLP and laboratory training sessions, TB isolates were collected at sentinel referral sites between 2009-2013 and tested for first-and second-line drug resistance.Results: From the analysis of 974 isolates, an unexpectedly high prevalence of multi-drug-resistant (MDR) strains was found in new (6 %) and retreatment patients (35 %) across all sentinel sites, with the highest prevalence amongst retreatment patients in Bamako, Mali (59 %) and the two Nigerian sites in Ibadan and Lagos (39 % and 66 %). In Lagos, MDR is already spreading actively amongst 32 % of new patients. Pre-extensively drug-resistant (pre-XDR) isolates are present in all sites, with Ghana showing the highest proportion (35 % of MDR). In Ghana and Togo, pre-XDR isolates are circulating amongst new patients.Conclusions: West African drug-resistance prevalence poses a previously underestimated, yet serious public health threat, and our estimates obtained differ significantly from previous World Health Organisation (WHO) estimates. Therefore, our data are reshaping current concepts and are essential in informing WHO and public health strategists to implement urgently needed surveillance and control interventions in West Africa.
AB - Background: Drug-resistant tuberculosis (TB) is a global public health problem. Adequate management requires baseline drug-resistance prevalence data. In West Africa, due to a poor laboratory infrastructure and inadequate capacity, such data are scarce. Therefore, the true extent of drug-resistant TB was hitherto undetermined. In 2008, a new research network, the West African Network of Excellence for Tuberculosis, AIDS and Malaria (WANETAM), was founded, comprising nine study sites from eight West African countries (Burkina Faso, The Gambia, Ghana, Guinea-Bissau, Mali, Nigeria, Senegal and Togo). The goal was to establish Good Clinical Laboratory Practice (GCLP) principles and build capacity in standardised smear microscopy and mycobacterial culture across partnering laboratories to generate the first comprehensive West African drug-resistance data.Methods: Following GCLP and laboratory training sessions, TB isolates were collected at sentinel referral sites between 2009-2013 and tested for first-and second-line drug resistance.Results: From the analysis of 974 isolates, an unexpectedly high prevalence of multi-drug-resistant (MDR) strains was found in new (6 %) and retreatment patients (35 %) across all sentinel sites, with the highest prevalence amongst retreatment patients in Bamako, Mali (59 %) and the two Nigerian sites in Ibadan and Lagos (39 % and 66 %). In Lagos, MDR is already spreading actively amongst 32 % of new patients. Pre-extensively drug-resistant (pre-XDR) isolates are present in all sites, with Ghana showing the highest proportion (35 % of MDR). In Ghana and Togo, pre-XDR isolates are circulating amongst new patients.Conclusions: West African drug-resistance prevalence poses a previously underestimated, yet serious public health threat, and our estimates obtained differ significantly from previous World Health Organisation (WHO) estimates. Therefore, our data are reshaping current concepts and are essential in informing WHO and public health strategists to implement urgently needed surveillance and control interventions in West Africa.
KW - Tuberculosis
KW - Extensively drug-resistant tuberculosis
KW - West Africa
KW - Drug-resistance surveillance
KW - Capacity building
KW - MYCOBACTERIUM-TUBERCULOSIS
KW - NIGERIA
KW - PREVALENCE
KW - TB
U2 - 10.1186/s12916-016-0704-5
DO - 10.1186/s12916-016-0704-5
M3 - A1: Web of Science-article
SN - 1741-7015
VL - 14
JO - BMC Medicine
JF - BMC Medicine
M1 - 160
ER -