Prevalence, risk factors and treatment outcomes of isoniazid resistant TB in Bulawayo city, Zimbabwe: A cohort study

  • Barbara Manyame-Murwira National Tuberculosis Reference Laboratory, Ministry of Health and Child Care, Bulawayo, Zimbabwe
  • Kudakwashe Collins Takarinda AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
  • Pruthu Thekkur Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France
  • Bright Payera National Tuberculosis Reference Laboratory, Ministry of Health and Child Care, Bulawayo, Zimbabwe
  • Herbert Mutunzi AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
  • Raiva Simbi Department of Laboratory Services, Ministry of Health and Child Care, Harare, Zimbabwe
  • Nicholas Siziba AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
  • Edwin Sibanda Department of Health, Bulawayo City Council, Zimbabwe
  • Catherine Banana Department of Health, Bulawayo City Council, Zimbabwe
  • Norbert Muleya Department of Environmental Health Services, Ministry of Health and Childcare, Matebeleland South, Zimbabwe
  • Evidence Makombe Department of laboratory Services, Ministry of Health and Childcare, Midlands Province, Zimbabwe
  • Paula Littia Jongwe National Tuberculosis Reference Laboratory, Ministry of Health and Child Care, Bulawayo, Zimbabwe
  • Regina Bhebhe National Tuberculosis Reference Laboratory, Ministry of Health and Child Care, Bulawayo, Zimbabwe
  • Douglas Mangwanya Department of Laboratory Services, Ministry of Health and Child Care, Harare, Zimbabwe
  • Janet Dzangare AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
  • Fungai Hamilton Mudzengerere Family Health International (FHI360), Harare, Zimbabwe
  • Collins Timire AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
  • Enock Wekiya WHO Supra National Reference Laboratory/National Tuberculosis Reference Laboratory, Uganda
  • Charles Sandy AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
Keywords: Tuberculosis, Isoniazid mono-resistance, IPT, Operational Research, SORT-IT

Abstract

Introduction: The isoniazid-resistant TB poses a threat to TB control efforts. Zimbabwe, one of the high TB burden countries, has not explored the burden of isoniazid resistant TB. Hence among all bacteriologically-confirmed TB patients diagnosed in Bulawayo City during March 2017 and December 2018, we aimed to assess the proportion with isoniazid resistant TB and associated factors. Also, we aimed to describe the TB treatment outcomes.

Methodology: A cohort study involving routinely collected data by the National TB Reference Laboratory (NTBRL) in Bulawayo City and National TB programme of Zimbabwe. The percentage with 95% confidence interval (CI) was used to express the proportion with isoniazid-resistant TB. The modified Poisson regression was used to assess the association of demographic and clinical characteristics with isoniazid mono-resistant TB.

Results: Of 2160 bacteriologically-confirmed TB patients, 1612 (74.6%) had their sputum received at the NTBRL and 743 (46.1%) had culture growth. Among those with culture growth, 34 (4.6%, 95% CI: 3.5-6.7) had isoniazid mono-resistant TB, 25 (3.3%, 95% CI: 2.2-4.9) had MDR-TB. Thus, 59 (7.9%, 95% CI: 6.1-10.1) had isoniazid-resistant TB. Children < 15 years had a higher prevalence of isoniazid mono-resistant TB (aPR= 3.93; 95% CI: 1.24-12.45). Among those with rifampicin sensitive TB, patients with isoniazid-sensitive TB had higher favourable treatment outcomes compared to those with isoniazid-resistant TB (86.3% versus 75.5%, p = 0.039).

Conclusions: The prevalence of isoniazid-resistant TB was low compared to neighbouring countries with high burden of TB-HIV. However, Zimbabwe should consider reviewing treatment guidelines for isoniazid mono-resistant TB due to the observed poor treatment outcomes.

Author Biographies

Kudakwashe Collins Takarinda, AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe

Senior Operations Research Officer

Pruthu Thekkur, Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France

Monitoring and Evaluation Officer, Centre for Operational Research

Bright Payera, National Tuberculosis Reference Laboratory, Ministry of Health and Child Care, Bulawayo, Zimbabwe

Medical scientist

Herbert Mutunzi, AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe

NATIONAL TB COORDINATOR

Raiva Simbi, Department of Laboratory Services, Ministry of Health and Child Care, Harare, Zimbabwe

DEPUTY DIRECTOR OF LABORATORY SERVICES

Nicholas Siziba, AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe

MONITORING AND EVALUATION OFFICER

Edwin Sibanda, Department of Health, Bulawayo City Council, Zimbabwe

DIRECTOR

Catherine Banana, Department of Health, Bulawayo City Council, Zimbabwe

SENIOR NURSING OFFICER

Norbert Muleya, Department of Environmental Health Services, Ministry of Health and Childcare, Matebeleland South, Zimbabwe

PROVINCIAL TB COORDINATOR

Evidence Makombe, Department of laboratory Services, Ministry of Health and Childcare, Midlands Province, Zimbabwe

PROVINCIAL SCIENTIST

Paula Littia Jongwe, National Tuberculosis Reference Laboratory, Ministry of Health and Child Care, Bulawayo, Zimbabwe

MEDICAL SCIENTIST

Regina Bhebhe, National Tuberculosis Reference Laboratory, Ministry of Health and Child Care, Bulawayo, Zimbabwe

MEDICAL SCIENTIST

Douglas Mangwanya, Department of Laboratory Services, Ministry of Health and Child Care, Harare, Zimbabwe

DIRECTOR

Janet Dzangare, AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe

HIV/STI & TB Surveillance  Officer

Fungai Hamilton Mudzengerere, Family Health International (FHI360), Harare, Zimbabwe

Knowledge management and Operations Research Officer,

Collins Timire, AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe

Senior Operations Research Fellow

Charles Sandy, AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe

DEPUTY DIRECTOR OF TB PROGRAMME

 

Published
2020-08-31
How to Cite
1.
Manyame-Murwira B, Takarinda KC, Thekkur P, Payera B, Mutunzi H, Simbi R, Siziba N, Sibanda E, Banana C, Muleya N, Makombe E, Jongwe PL, Bhebhe R, Mangwanya D, Dzangare J, Mudzengerere FH, Timire C, Wekiya E, Sandy C (2020) Prevalence, risk factors and treatment outcomes of isoniazid resistant TB in Bulawayo city, Zimbabwe: A cohort study. J Infect Dev Ctries 14:893-900. doi: 10.3855/jidc.12319
Section
Original Articles