Value of pre-licensure interprofessional education on post-licensure interprofessional collaboration: Perceptions and experiences of practicing professionals.

Interprofessional education (IPE) allows students in health professional programs to practice providing collaborative patient care before graduating. Understanding the perceptions and experiences of health care professionals' IPE received prior to entering the workforce is key for improving IPE programs. This study investigated participants' post-licensure interprofessional collaboration (IPC) experiences, how IPE helped prepare them for IPC post-licensure, their perceptions of the IPE they received as students, and their suggestions for improving IPE. This qualitative descriptive study included 20 healthcare workers from seven professions who graduated from two of three co-located post-secondary educational institutions. Data were collected using semi-structured interviews, which were audiotaped and transcribed verbatim. Inductive thematic analysis revealed five themes and six sub-themes: (a) Quality of care; (b) Role clarification; (c) Interpersonal skills (sub-themes: communication and self-confidence); (d) Co-location; and (e) Need for IPE improvements (sub-themes: additional IPE exposures, shadowing experiences, mandatory IPE, and informal peer learning). These findings appear to reinforce the perception that pre-licensure IPE may support the development of skills for IPC among practicing health professionals.

Fitness costs of rifampicin resistance in Mycobacterium tuberculosis are amplified under conditions of nutrient starvation and compensated by mutation in the ß' subunit of RNA polymerase.

Rifampicin resistance, a defining attribute of multidrug-resistant tuberculosis, is conferred by mutations in the ß subunit of RNA polymerase. Sequencing of rifampicin-resistant (RIF-R) clinical isolates of Mycobacterium tuberculosis revealed, in addition to RIF-R mutations, enrichment of potential compensatory mutations around the double-psi ß-barrel domain of the ß' subunit comprising the catalytic site and the exit tunnel for newly synthesized RNA. Sequential introduction of the resistance allele followed by the compensatory allele in isogenic Mycobacterium smegmatis showed that these mutations respectively caused and compensated a starvation enhanced growth defect by altering RNA polymerase activity. While specific combinations of resistance and compensatory alleles converged in divergent lineages, other combinations recurred among related isolates suggesting transmission of compensated RIF-R strains. These findings suggest nutrient poor growth conditions impose larger selective pressure on RIF-R organisms that results in the selection of compensatory mutations in a domain involved in catalysis and starvation control of RNA polymerase transcription.

Utility of the REBA MTB-Rifa® assay for rapid detection of rifampicin resistant Mycobacterium tuberculosis.

BACKGROUND: Drug-resistant tuberculosis (TB), including resistance to both rifampicin (RIF) and isoniazid (INH) referred to as multidrug-resistant tuberculosis (MDR-TB), has become an increasing global threat in recent years. Effective management of patients infected with MDR-TB strains requires identifying such patients by performing conventional drug-susceptibility testing (DST) on bacteria isolated from sputum, a process that can take up to 2 months. This delay in diagnosis can result in worsening and continued transmission of MDR-TB. Molecular methods that rely upon nucleic acid amplification of specific alleles known to be associated with resistance to specific drugs have been helpful in shortening the time to detect drug resistant TB. METHODS: We investigated the utility of the REBA MTB-Rifa®, a commercially available line probe assay (LPA) for detecting rifampicin (RIF) resistance in the RIF resistance-determining region (RRDR) of the rpoB gene. Altogether, 492 Mycobacterium tuberculosis (M. tuberculosis) clinical isolates and additional 228 smear- and culture-positive sputum samples with confirmed M. tuberculosis were collected from subjects with suspected MDR-TB in South Korea. The results were compared with conventional phenotypic DST and sequencing of the rpoB gene. RESULTS: A total of 215 of the 492 isolates were resistant to RIF by conventional DST, and of which 92.1% (198/215) were MDR-TB strains. The REBA MTB-Rifa® assay identified RIF resistance in 98.1% (211/215) of these isolates but failed to identify resistance in four phenotypically RIF resistant isolates. These four isolates lacked mutations in the RRDR but three were confirmed to be MDR-TB strains by sequencing. The sensitivity and specificity of this test for clinical isolates was thus 98.1% (211/215) and 100% (277/277), respectively. When applied directly to 228 smear positive sputum samples, the sensitivity and the specificity of REBA MTB-Rifa® assay was 100% (96/96, 132/132), respectively. CONCLUSIONS: These findings support the use of the REBA MTB-Rifa® assay for rapid detection of RIF resistance on clinical isolates and smear positive sputum samples. The results also suggest that RIF resistance is a good surrogate marker of MDR-TB in South Korea and the need to add more probes to other LPAs which can cover newly identified mutations relevant to RIF resistance.

Strategies Used in Canadian Nursing Programs to Prepare Students for NCLEX-RN® Licensure Exam.

Nursing educators need strategies for preparing students to be successful in the National Council Licensure Examination (NCLEX-RN®). Understanding the educational practices used is an important step in informing curricular decisions and helping regulatory agencies evaluate nursing programs' efforts to prepare students for practice. This study described strategies used in Canadian nursing programs to prepare students for the NCLEX-RN®. A cross-sectional descriptive national survey was completed by the program's director, chair, dean, or another faculty member involved in the program's NCLEX-RN® preparatory strategies using the LimeSurvey platform. Most participating programs (n = 24; 85.7%) use one to three strategies to prepare students for the NCLEX-RN®. Strategies include the requirement to purchase a commercial product, the administration of computer-based exams, NCLEX-RN® preparation courses or workshops, and time dedicated to NCLEX-RN® preparation in one or more courses. There is variation among Canadian nursing programs in how students are prepared for the NCLEX-RN®. Some programs invest considerable effort in preparation activities, while others have limited ones.

Structural Origins of Poor Health Outcomes in Documented Temporary Foreign Workers and Refugees in High-Income Countries: A Review.

Despite growing evidence of racial and institutional discrimination on minoritized communities and its negative effect on health, there are still gaps in the current literature identifying health disparities among minoritized communities. This review aims to identify health barriers faced by relatively less studied migrant subgroups including documented temporary foreign workers and refugees residing in high-income Organisation for Economic Co-operation and Development (OECD) countries focusing on the structural origins of differential health outcomes. We searched Medline, CINAHL, and Embase databases for papers describing health barriers for these groups published in English between 1 January 2011 and 30 July 2021. Two independent reviewers conducted a title, abstract, and full text screening with any discrepancies resolved by consensus or a third reviewer. Extracted data were analyzed using an inductive thematic analysis. Of the 381 articles that underwent full-text review, 27 articles were included in this review. We identified housing conditions, immigration policies, structural discrimination, and exploitative labour practices as the four major emerging themes that impacted the health and the access to healthcare services of our study populations. Our findings highlight the multidimensional nature of health inequities among migrant populations and a need to examine how the broader context of these factors influence their daily experiences.

Nursing Home Residents' Use of Radiography in New Brunswick: A Case for Mobile Radiography?

Introduction: Identifying ways to eliminate unnecessary transfer of nursing home (NH) residents to hospitals provides an opportunity to improve outcomes and use scarce healthcare resources more efficiently. This study's goal was to better understand where NH residents access X-ray (XR) and computed tomography (CT) scans and to determine if there was a case for mobile radiography policies in New Brunswick. Methods: A retrospective analysis of all the visits to the emergency department (ED) and outpatient imaging departments in two hospitals in Saint John, New Brunswick, in 2020, that involved XR or CT investigations was conducted. Results: There were 521 visits by 311 unique NH residents and 920 investigations (688 XR and 232 CT scans). Most investigations were ordered in the ED (696 of 920; 75.6%; confidence interval: 72.8-78.3%). Of the NH residents who visited the ED and received either an XR or a CT scan, 33.2% received only XR imaging and were discharged back to the NH after a mean ED stay of 5.15 hours. Discussion: The pattern of NH residents' use of the ED for their imaging needs supports the creation of mobile XR policies to deliver more safe and efficient care in a Canadian medium population urban centre.

Tuberculosis related barriers and facilitators among immigrants in Atlantic Canada: A qualitative study.

Tuberculosis (TB) is a disease caused by the bacterium Mycobacterium tuberculosis and affects approximately one-quarter of the world's population. Immigrant populations in Canada are disproportionately affected by TB. Canada's immigration medical examinations include screening for active TB but not latent TB infection (LTBI). In LTBI, the bacterium remains dormant within the host but can reactivate and cause disease. Once active, TB can be transmitted to close contacts sharing confined spaces leading to the possibility of outbreaks in the broader community. This study aimed to 1) assess the current TB knowledge, perceived risk, and risk behaviors of immigrants in Atlantic Canada as well as 2) identify barriers and facilitators to testing and treatment of TB among this population. Three focus group discussions were conducted with a total of 14 non-Canadian born residents of New Brunswick aged 19 years and older. Data were analyzed using inductive thematic analysis. Four themes were identified from the data relating to barriers to testing and treatment of LTBI: 1) Need for education, 2) stigma, 3) fear of testing, treatment, and healthcare system, and 4) complacency. Results included reasons individuals would not receive TB testing, treatment, or seek help, as well as facilitators to testing and treatment. These findings may inform the implemention of an LTBI screening program in Atlantic Canada and more broadly across the country.

Exploring the Efficacy of a Virtual First Year Interprofessional Education Event.

Interprofessional education (IPE) activities are utilized in health education programs to develop interprofessional collaboration (IPC) competencies. All first-year healthcare students at three postsecondary learning institutions attend a mandatory introductory IPE event annually. During the 2020/2021 academic year, the event was moved from a face-to-face activity to a virtual format due to the COVID-19 pandemic restrictions. This study examined whether the virtual IPE activity was effective in supporting the development of interprofessional competencies for first-year healthcare students. Two hundred and six students attended a synchronous didactic presentation on IPE competencies and discussed a simulated case in interprofessional groups of eight students and two faculty facilitators. The Interprofessional Collaborative Competency Attainment Survey (ICCAS) was used to measure the students' opinions on interprofessional competencies. Paired t-tests were used to compare the pre- and post-scores. One hundred and nine (52.9% response rate) students completed the survey. Surveys from 99 students with matched pre- and post-scores were included in the study. The ICCAS competencies showed improvements (p < 0.05) in all of the students' self-reported IPE competencies following the activity compared to before the training. Our findings indicate that the virtual IPE activity is effective in facilitating the development of IPC for first-year healthcare students.

Optimizing tuberculosis screening for immigrants in southern New Brunswick: A pilot study protocol.

INTRODUCTION: Immigrants from high tuberculosis-burdened countries have been shown to have an increased risk of latent tuberculosis infection (LTBI). To reduce the risk of increased tuberculosis cases in Canada, the country has a comprehensive immigration medical examination process that identifies individuals with active tuberculosis using chest X-ray; however, it fails to identify LTBI. The lack of LTBI identification is concerning because immigrants with LTBI are at an increased risk of developing active tuberculosis within their first few years of migration due to stressful experiences common to many immigrants. OBJECTIVES: The goal of this pilot study is to improve the current LTBI screening protocols among immigrants from high tuberculosis incidence countries and to better prevent and manage tuberculosis cases, by introducing an LTBI screening pilot program. The objectives are threefold: 1) to screen LTBI in immigrants from high tuberculosis incidence countries, including immigrants identified as being at risk of LTBI by the NB health care system, using the QuantiFERON-TB Gold Plus interferon-gamma release assay (IGRA); 2) to offer LTBI treatment and supports to those identified as having LTBI; and 3) to assess immigrant and health care providers (HCPs) satisfaction of the LTBI screening pilot program. METHODS: This cross-sectional study seeks to recruit 288 participants. Participants will be recruited via posters, social media platforms, invitations at immigrant wellness check-ups, presentations to local ethnocultural groups, and by snowball sampling. Consenting participants will be asked to submit a blood sample for LTBI screening; if positive, participants will be assessed and offered treatment for LTBI based on clinical assessment. Participants and HCPs' feedback will be gathered via short questionnaires. For the quantitative portion of the study, descriptive statistics will be used to summarize participant characteristics and feedback. Simultaneous logistic regression will be performed to identify variables associated with the IGRA test outcome and evidence of increased CD8 T-cell immune response among those found to be LTBI-positive. Qualitative results will be analyzed using inductive thematic analysis. DISCUSSION: The findings from this study will allow us to understand the role of the IGRA LTBI screening assay and its feasibility and acceptability by immigrants and HCPs in New Brunswick. The findings will additionally provide information on the enhancers and barriers of LTBI screening and management useful in determining how best to expand the LTBI screening program if deemed appropriate.

Concept Analysis and Proposed Definition of Community Health Center.

Background: Community health centers (CHCs) have been used for delivery of health services since the 1920s and originally were intended to provide care to underserved populations. CHCs have become an integral part of healthcare systems in many countries; however, the term CHC is used synonymously with other concepts and there is no clear definition for CHC. The purpose of our concept analysis was to determine how CHCs are described in the literature and to develop a concept definition for CHC. Methods: Informed by the 8-step process described by Walker and Avant, we searched for literature spanning disciplines within health, business, and policy. We used a systematic review process to identify a range of peer-reviewed articles that help illustrate the attributes, antecedents, and consequences of CHCs. A total of 102 articles from 7 databases were included in our concept analysis. Results: We distinguished 6 attributes of a CHC: primary care; accessibility; preventative care; defined population; health promotion; and comprehensive and integrated care. About 4 antecedents fundamental to a CHC included: secure funding; vision and support; adequate human resources; and governance structure. Consequences of CHCs are improved health outcomes, efficiency, and cost-effective provision of healthcare services. Conclusions: Our concept analysis revealed core characteristics of CHCs that assisted us in synthesizing a concept definition for CHC. These characteristics and our proposed definition will help provide clarity on the concept of CHC to benefit evaluation, research, and policy development of CHCs.

Genetic diversity of Mycobacterium tuberculosis isolates from a tertiary care tuberculosis hospital in South Korea.

Tuberculosis (TB) remains an immense public health problem in the Republic of Korea despite a more than fivefold decrease in the prevalence of the disease over the last 3 decades. The rise in drug-resistant TB has compounded the situation. We analyzed 208 clinical isolates of M. tuberculosis from the National Masan Tuberculosis Hospital by spoligotyping, IS6110 restriction fragment length polymorphism (RFLP), and 24-locus-based mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) typing to assess the diversity and transmission dynamics of the tubercle bacilli in the Republic of Korea. The majority of the isolates (97.1%) belonged to the Beijing genotype. Cluster analysis by MIRU-VNTR yielded a low clustering rate of 22.3%, with most of the clusters comprising isolates with diverse drug resistance patterns. The discriminatory capacity of the typing methods was high for RFLP and MIRU-VNTR (allelic diversity [h] = 0.99) but low for spoligotyping (h = 0.31). Although analysis of 19 MIRU-VNTR loci was needed to achieve maximum discrimination, an informative set of 8 loci (960, 1955, 2163b, 2165, 2996, 3192, 4052, and 4348) (h = 0.98) that was able to differentiate most of the closely related strains was identified. These findings suggest that 24-locus-based MIRU-VNTR typing is a likely suitable alternative to RFLP to differentiate clinical isolates in this setting, which is dominated by M. tuberculosis Beijing strains. Within the study limits, our results also suggest that the problem of drug-resistant TB in the Republic of Korea may be largely due to acquired resistance as opposed to transmission.

Polymorphisms associated with resistance and cross-resistance to aminoglycosides and capreomycin in Mycobacterium tuberculosis isolates from South Korean Patients with drug-resistant tuberculosis.

The aminoglycosides streptomycin, amikacin, and kanamycin and the cyclic polypeptide capreomycin are all widely used in second-line therapy for patients who develop multidrug-resistant tuberculosis. We have characterized a set of 106 clinical isolates of Mycobacterium tuberculosis using phenotypic drug susceptibility testing (DST) to determine the extent of resistance to each agent and cross-resistance between agents. These results were compared with polymorphisms in the DNA sequences of ribosome-associated genes previously implicated in resistance and with the clinical outcomes of subjects from whom these isolates were obtained. Thirty-six (34%) of these isolates displayed resistance to one or more of these agents, and the majority of these (20 of 36) showed cross-resistance to one or more agents. Most (33 of 36) of the resistant isolates showed polymorphisms in the 16S ribosome components RpsL and rrs. Three resistant strains (3 of 36) were identified that had no known polymorphisms in ribosomal constituents. For kanamycin and streptomycin, molecular DST significantly outperformed phenotypic DST using the absolute concentration method for predicting 4-month sputum conversion (likelihood ratios of 4.0 and 2.0, respectively) and was equivalent to phenotypic DST using the National Committee for Clinical Laboratory Standards (NCCLS)-approved agar proportion method for estimating MIC (likelihood ratio, 4.0). These results offer insight into mechanisms of resistance and cross-resistance among these agents and suggest that the development of rapid molecular tests to distinguish polymorphisms would significantly enhance clinical utility of this important class of second-line antituberculosis drugs.

Management of pulmonary tuberculosis patients in an urban setting in Zambia: a patient's perspective.

BACKGROUND: Zambia continues to grapple with a high tuberculosis (TB) burden despite a long running Directly Observed Treatment Short course programme. Understanding issues that affect patient adherence to treatment programme is an important component in implementation of a successful TB control programme. We set out to investigate pulmonary TB patient's attitudes to seek health care, assess the care received from government health care centres based on TB patients' reports, and to seek associations with patient adherence to TB treatment programme. METHODS: This was a cross-sectional study of 105 respondents who had been registered as pulmonary TB patients (new and retreatment cases) in Ndola District between January 2006 and July 2007. We administered a structured questionnaire, bearing questions to obtain individual data on socio-demographics, health seeking behaviour, knowledge on TB, reported adherence to TB treatment, and health centre care received during treatment to consenting respondents. RESULTS: We identified that respondents delayed to seek treatment (68%) even when knowledge of TB symptoms was high (78%) or when they suspected that they had TB (73%). Respondent adherence to taking medication was high (77%) but low adherence to submitting follow-up sputum (47%) was observed in this group. Similarly, caregivers educate their patients more often on the treatment of the disease (98%) and drug taking (100%), than on submitting sputum during treatment (53%) and its importance (54%). Respondent adherence to treatment was significantly associated with respondent's knowledge about the disease and its treatment (p < 0.0001), and with caregiver's adherence to treatment guidelines (p = 0.0027). CONCLUSIONS: There is a need to emphasise the importance of submitting follow-up sputum during patient education and counselling in order to enhance patient adherence and ultimately treatment outcome.

Methods for Detecting Mycobacterial Mixed Strain Infections-A Systematic Review.

Mixed strain infection (MSI) refers to the concurrent infection of a susceptible host with multiple strains of a single pathogenic species. Known to occur in humans and animals, MSIs deserve special consideration when studying transmission dynamics, evolution, and treatment of mycobacterial diseases, notably tuberculosis in humans and paratuberculosis (or Johne's disease) in ruminants. Therefore, a systematic review was conducted to examine how MSIs are defined in the literature, how widespread the phenomenon is across the host species spectrum, and to document common methods used to detect such infections. Our search strategy identified 121 articles reporting MSIs in both humans and animals, the majority (78.5%) of which involved members of the Mycobacterium tuberculosis complex, while only a few (21.5%) examined non-tuberculous mycobacteria (NTM). In addition, MSIs exist across various host species, but most reports focused on humans due to the extensive amount of work done on tuberculosis. We reviewed the strain typing methods that allowed for MSI detection and found a few that were commonly employed but were associated with specific challenges. Our review notes the need for standardization, as some highly discriminatory methods are not adapted to distinguish between microevolution of one strain and concurrent infection with multiple strains. Further research is also warranted to examine the prevalence of NTM MSIs in both humans and animals. In addition, it is envisioned that the accurate identification and a better understanding of the distribution of MSIs in the future will lead to important information on the epidemiology and pathophysiology of mycobacterial diseases.

Possible outbreak of streptomycin-resistant Mycobacterium tuberculosis Beijing in Benin.

Using geographic information system and molecular tools, we characterized a possible outbreak of tuberculosis caused by Mycobacterium tuberculosis Beijing strain in 17 patients in Cotonou, Benin, during July 2005-October 2006. Most patients lived or worked in the same area and frequented the same local drinking bar. The isolates were streptomycin resistant.

Isolation and characterization of Mycobacterium bovis strains from indigenous Zambian cattle using Spacer oligonucleotide typing technique.

BACKGROUND: Bovine tuberculosis (BTB), caused by Mycobacterium bovis, has remained a major source of concern to public health officials in Zambia. Previous investigations have used traditional epidemiological methods that are unable to identify the causative agent and from which dynamics of disease dispersion is difficult to discern. The objective of this study was to isolate, characterize and determine the genetic diversity and relatedness of M. bovis from major cattle rearing districts in Zambia by spoligotyping. A total of 695 carcasses were examined and 98 tissues had gross post-mortem lesions compatible with BTB. RESULTS: Forty-two out of the ninety-eight suspected tissues examined had culture properties characteristic of mycobacteria from which 31 isolates yielded interpretable spoligotypes. This technique showed good discriminatory power (HGDI = 0.98), revealing 10 different spoligotype patterns. Twenty-seven isolates belonged to one cluster with more than 95% similarity and inside the cluster, one predominant spoligotype was found in 20 (64.5%) of the isolates tested. The highest number of spoligotypes was observed among samples from Namwala district. Spoligotypes from 26 (83.9%) of the isolates belonged to five spoligotypes that have been reported before while the remaining 5 (16.1%) isolates had unique spoligotypes that are being reported for the first time; these have been assigned numbers SB1763 to SB1767. Five of the 6 districts had the predominant spoligotype (SB0120). CONCLUSION: The study has described the dispersion patterns of M. bovis in Zambian cattle for the first time and has identified 5 spoligotype patterns specific to Zambia. The observation of an overlap in the spoligotype pattern SB0120 in 5 of the 6 districts suggests the probability of sharing a common source of infection.

Evolutionary history and global spread of the Mycobacterium tuberculosis Beijing lineage.

Mycobacterium tuberculosis strains of the Beijing lineage are globally distributed and are associated with the massive spread of multidrug-resistant (MDR) tuberculosis in Eurasia. Here we reconstructed the biogeographical structure and evolutionary history of this lineage by genetic analysis of 4,987 isolates from 99 countries and whole-genome sequencing of 110 representative isolates. We show that this lineage initially originated in the Far East, from where it radiated worldwide in several waves. We detected successive increases in population size for this pathogen over the last 200 years, practically coinciding with the Industrial Revolution, the First World War and HIV epidemics. Two MDR clones of this lineage started to spread throughout central Asia and Russia concomitantly with the collapse of the public health system in the former Soviet Union. Mutations identified in genes putatively under positive selection and associated with virulence might have favored the expansion of the most successful branches of the lineage.

Isolation and molecular characterization of Mycobacterium tuberculosis from humans and cattle in Namwala District, Zambia.

Mycobacterium tuberculosis, the causative agent of tuberculosis in humans, is considered primarily a human pathogen. It has, however, been reported in a wide range of domestic and wild animals, often living in close prolonged contact with humans. Sputum samples in which acid fast bacteria were detected in smears were collected from patients at three health facilities in Namwala district, Zambia. Samples from cattle presenting gross lesions compatible with bovine tuberculosis were collected at a local abattoir in the same district. Isolated mycobacteria were identified and genotyped using classical molecular methods. From a total of 33 isolates of M. tuberculosis detected (30 from humans and 3 from cattle), two cattle isolates shared the same spoligotype and MIRU-VNTR pattern with a human patient. This study has for the first time documented the isolation of M. tuberculosis from cattle in Zambia and provides molecular evidence of an epidemiological link between M. tuberculosis isolates from humans and cattle in Namwala district. A possible spill back of M. tuberculosis to humans cannot be excluded and therefore further studies documenting to what extent M. tuberculosis is shed in cattle milk are needed. This finding further suggests that veterinary public health measures to control human TB, should also take into account the bovine reservoir.

Improved rapid molecular diagnosis of multidrug-resistant tuberculosis using a new reverse hybridization assay, REBA MTB-MDR.

Rapid diagnosis of multidrug-resistant tuberculosis (MDR-TB) is essential for the prompt initiation of effective second-line therapy to improve treatment outcome and limit transmission of this obstinate disease. A variety of molecular methods that enable the rapid detection of mutations implicated in MDR-TB have been developed. The sensitivity of the methods is dependent, in principle, on the repertoire of mutations being detected, which is typically limited to mutations in the genes rpoB, katG and the promoter region of inhA. In this study, a new reverse hybridization assay, REBA MTB-MDR (M&D), that probes mutations in the oxyR-ahpC intergenic region, in addition to those in rpoB, katG and the inhA promoter region, was evaluated. A set of 240 Mycobacterium tuberculosis clinical isolates from patients receiving retreatment regimens was subjected to conventional phenotypic drug-susceptibility testing (DST) and the REBA MTB-MDR assay. The nucleotide sequences of the loci known to be involved in drug resistance were determined for comparison. In brief, the results showed that the REBA MTB-MDR assay efficiently recognized nucleotide changes in the oxyR-ahpC intergenic region as well as those in rpoB, katG and the inhA promoter region with higher sensitivity, resulting in an 81.0 % detection rate for isoniazid resistance. Inclusion of the oxyR-ahpC intergenic region in the REBA MTB-MDR assay improved the overall sensitivity of molecular DST for MDR-TB from 73.1 to 79.9 %.

Low Occurrence of Tuberculosis Drug Resistance among Pulmonary Tuberculosis Patients from an Urban Setting, with a Long-Running DOTS Program in Zambia.

We set out to determine the levels of Mycobacterium tuberculosis resistance to first- and second-line TB drugs in an urban population in Zambia. Sputum samples were collected consecutively from all smear-positive, new and previously treated patients, from four diagnostic centres in Ndola between January and July 2006. Drug susceptibility testing was performed using the proportion method against four first- and two second-line TB drugs. Results. Among 156 new cases, any resistance was observed to be 7.7%, monoresistance to isoniazid and rifampicin was 4.5% and 1.3%, respectively. Of 31 retreatment cases, any resistance was observed to be 16.1%, monoresistance to isoniazid and rifampicin was 3.3% for each drug, and one case of resistance to both isoniazid and rifampicin (multidrug resistance) was detected. No resistance to kanamycin or ofloxacin was detected. Conclusion. Although not representative of the country, these results show low levels of drug resistance in a community with a long-standing DOTS experience. Resource constrained countries may reduce TB drug resistance by implementing community-based strategies that enhance treatment completion.