Drug-Resistant Tuberculosis in High-Risk Groups, Zimbabwe

John Z. Metcalfe

, Salome Makumbirofa, Beauty Makamure, Charles Sandy, Wilbert Bara, Stanley Mungofa, Philip C. Hopewell, and Peter Mason

Author affiliations: Curry International Tuberculosis Center–San Francisco General Hospital, San Francisco, California, USA (J.Z. Metcalfe, P.C. Hopewell); Biomedical Research and Training Institute, Harare, Zimbabwe (S. Makumbirofa, B. Makamure, P. Mason); National Tuberculosis Control Program, Harare, Zimbabwe (C. Sandy); Harare City Health Department, Harare, Zimbabwe (W. Bara, S. Mungofa); University of Zimbabwe College of Health Sciences, Harare (P. Mason)

Abstract

To estimate prevalence of multidrug-resistant tuberculosis (MDR TB) in Harare, Zimbabwe, in 2012, we performed microbiologic testing on acid-fast bacilli smear-positive sputum samples from patients previously treated for TB. Twenty (24%) of 84 specimens were consistent with MDR TB. A national drug-resistance survey is needed to determine MDR TB prevalence in Zimbabwe.

Emergence of multidrug-resistant tuberculosis (MDR TB) in sub-Saharan Africa poses a major risk to further destabilization of regional TB control programs. Yet, fewer than half of the 46 countries in the World Health Organization (WHO) African Region have provided representative drug-resistance data, and only 10 have reported data since 2007 (1).

Zimbabwe has among the highest estimated TB incidence per capita (603/100,000 population) in the world (2). Sixteen percent of adults are HIV infected, and approximately three-quarters of active TB cases occur among persons with HIV (3). Increasing prevalence (4) and epidemic spread (5) of MDR TB in neighboring southern Africa countries, sociopolitical instability with economic collapse and severe health system disruptions in 2007–2008 (6), and anecdotal reports of MDR TB among Zimbabwean returnees (7) may herald an increase in MDR TB prevalence within the country. Formal national surveillance for drug-resistant TB has not been undertaken in Zimbabwe since 1995. To improve early detection and estimate the prevalence of MDR TB, we performed extensive microbiologic testing on samples from consecutive patients with presumptive drug-resistant TB in Harare, Zimbabwe.