Heterogeneity of virological suppression in the national antiretroviral programme of Cameroon (ANRS 12288 EVOLCAM).

OBJECTIVES: In terms of HIV infection, western and central Africa is the second most affected region world-wide, and the gap between the regional figures for the testing and treatment cascade and the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets is particularly worrying. We assessed the prevalence of virological suppression in patients routinely treated in 19 hospitals in Cameroon. METHODS: A cross-sectional survey was performed in adult patients receiving antiretroviral therapy (ART) in the Centre and Littoral regions. The prevalences of virological suppression (<1000 HIV-1 RNA copies/mL) were compared among all 19 hospitals using the χ2 test. Potential individual and health care-related determinants of virological suppression were assessed using multivariate logistic regression models. RESULTS: A total of 1700 patients (74% women; median age 41 years; median time on ART 3.7 years) were included in the study. The prevalence of virological suppression was 82.4% overall (95% confidence interval 80.5-84.2%). It ranged from 57.1 to 97.4% according to the individual hospital (P < 0.001). After adjustment, virological suppression was associated with age, CD4 cell count at ART initiation, disclosure of HIV status to family members, interruption of ART for more than two consecutive days, and location of patient's residence and hospital (rural/urban). These factors did not explain the heterogeneity of virological suppression between the study hospitals (P < 0.001). CONCLUSIONS: The overall prevalence of virological suppression was reassuring. Nevertheless, the heterogeneity of virological suppression among hospitals highlights that, in addition to programme-level data, health facility-level data are crucial in order to tailor the national AIDS programme's interventions with a view to achieving the third UNAIDS 90 target.

[Kanamycin-induced ototoxicity during treatment of multidrug-resistant tuberculosis]. / Ototoxicité liée à la kanamycine au cours du traitement de la tuberculose multirésistante.

INTRODUCTION: Aminoglycosides are commonly used in the treatment of multidrug-resistant tuberculosis (MDR-TB). Their use can cause ototoxicity with irreversible hearing loss. The aim of this study was to determine the incidence and to identify factors associated to kanamycin-induced ototoxicity during MDR-TB treatment in Yaounde. METHODS: The records of patients hospitalized in the pulmonology department of the Jamot Hospital of Yaounde between May 2008 and July 2015 (7 years) for treatment of MDR-TB with regimens containing kanamycin were analyzed. Logistic regression was used to identify for factors associated with ototoxicity during this treatment. RESULTS: Of the 79 patients included, 60.7% were male and their median age (25th-75th percentile) was 31 (25-43) years. Eighteen (22.8%) patients had HIV infection. During treatment, the incidence of kanamycin-induced ototoxicity [95% confidence interval (95% CI)] was 36.7 (26.9-47.7) %. Factors independently associated with this ototoxicity [odds ratio (95% CI)] during MDR-TB treatment were age>40 years [13.47 (3.66-49.49)] and a body mass index<18.5kg/m2 [4.58 (1.36-15.44)]. CONCLUSION: The incidence of kanamycin-induced ototoxicity during MDR-TB treatment is relatively high. Taking these factors into consideration at the initiation of MDR-TB treatment would allow to reduce the occurrence of irreversible functional impairment induced by the treatment of MDR-TB.

Implementation of blanket provider-initiated testing and counselling: Predictors of HIV seropositivity among infants, children and adolescents in Cameroon.

Objectives: The number needed to test (NNT) to identify a child infected with HIV remains high in the context of the implementation of the blanket provider-initiated testing and counselling (bPITC) strategy. This study assessed the predictors of HIV seropositivity among outpatient children/adolescents (6 weeks-19 years) in Cameroon. This information is needed to improve the yield of bPITC and reduce the current gap in pediatric and adolescent ART coverage in this country and beyond. Study design: Cross-sectional study conducted in 3 hospitals in Cameroon. Methods: Through biological parents and guardians we systematically invited children and adolescents visiting the outpatient departments for any reason to test for HIV (bPITC) in a 6-month period. Children and adolescents were tested for HIV following the national guidelines and the predictors of HIV seropositivity were assessed using multivariate logistic regression at 5% significant level. Results: A total of 2729 eligible children/adolescents were enrolled. Among these, 90.3% (2465/2729) were tested for HIV. Out of these, 1.6% (40/2465) tested HIV-positive, corresponding to a NNT of 62. In multivariate analysis, HIV seropositivity was 2.5, 3.3, and 5 times more likely to be reported among children/adolescents of the female sex [aOR â€‹= â€‹0.4 (0.2-0.8), p â€‹= â€‹0.008]; whose fathers had no formal school education [aOR â€‹= â€‹0.3 (0.1-0.6), p â€‹= â€‹0.004] and those whose mothers had died [aOR â€‹= â€‹0.2 (0.0-0.9), p â€‹= â€‹0.041], respectively. Conclusions: Focusing HIV testing among female children/adolescents, whose fathers had no education level and whose mothers had died could reduce the NNT, improve the yield of bPITC and increase the pediatric and adolescent ART coverage.

Non conversion of sputum smears in new smear positive pulmonary tuberculosis patients in Yaoundé, Cameroon.

OBJECTIVES: To identify clinical, radiological and microbiological factors associated with the non conversion of sputum smears in new smear positive cases of pulmonary tuberculosis after two months of treatment and to evaluate the influence of non-smear conversion on treatment outcomes. DESIGN: A prospective cohort study. SETTING: Tuberculosis centre of Hôpital Jamot in Yaoundé- Cameroon from April 2006 to September 2007. SUBJECTS: A total of 413 patients were studied. MAIN OUTCOME MEASURES: Sputum smear status at two months of treatment, favourable treatment outcome (cured, treatment completed), unfavourable treatment outcome (death, treatment failure, default from treatment) and transferred out. RESULTS: A total of 413 patients were studied; There were 234 (56.8%) males and 178 (43.2%) females with a mean age of 33 years (range 9.80 years). Sputum smears did not convert in 55 (13.4%) patients at the end of two months of treatment. Logistic regression analysis showed that age above or equal to 40 years (OR=2.716, 95% CI:1.412-5.223, p=0.003), and a bacillary load of 3+ on pre-treatment sputum smears (OR=1.955; 95% CI: 1.039-3.68, p=0.037) were significantly associated with non conversion of sputum smears at the end of two months of treatment. Persistent positive smears at the end of two months of treatment were significantly associated with unfavourable treatment outcomes (p=0.025) especially default during the course of treatment. CONCLUSION: In Yaoundé, Cameroon, non conversion of positive sputum smears in new patients with pulmonary tuberculosis at the end of two months of treatment is associated with an unfavourable outcome particularly defaulting later in the course of treatment. Non conversion of sputum smears at two months of treatment is significantly associated with age above or equal to 40 years and the presence of numerous bacilli (3+) on pre-treatment sputum smears. Patients with these factors who do not smear convert after two months of treatment should be given a fully supervised treatment for the entire duration of therapy so as to prevent in particular treatment default.

Gatifloxacin is superior to levofloxacin and moxifloxacin in shorter treatment regimens for multidrug-resistant TB.

SETTING: Data were collected from patients starting one of the shorter treatment regimens (STRs) for multidrug-resistant tuberculosis (MDR-TB) in Bangladesh, Niger or Cameroon.OBJECTIVE: To estimate the effect of either a gatifloxacin (GFX), moxifloxacin (MFX) or levofloxacin (LVX) based STR on bacteriological effectiveness.DESIGN: Retrospective study of prospectively collected data.RESULTS: Among 1530 patients, bacteriological effectiveness was 96.7% overall. Stratified by treatment with a GFX-, LVX- or MFX-based regimen effectiveness was respectively 97.5%, 95.5% and 94.7%. Compared to those on a GFX-based regimen, the estimated summary odds ratio of having an adverse outcome was more than double (OR 2.05, 95% CI 1.09-3.90) in patients treated with either an LVX-based or MFX-based regimen. After adjusting for initial resistance, patients treated with an LVX-based regimen and MFX-based regimen had respectively a 4.5- and 8.4-fold times larger odds of an adverse bacteriological outcome. None among 859 patients at risk treated with a GFX-based compared to at least 4 of 228 among those on an MFX-based regimen acquired fluoroquinolone resistance.CONCLUSION: GFX-based regimens had superior bacteriological effectiveness than MFX-based or LVX-based regimens. As GFX is currently unavailable in most MDR-TB programs, its reintroduction should be prioritised.

Pre-treatment loss to follow-up of pulmonary tuberculosis patients in two regions of Cameroon.

SETTING: Thirty-nine tuberculosis diagnosis and treatment units (DTUs) in the North-West and South-West Regions of Cameroon. OBJECTIVE: To determine the proportion of pre-treatment loss to follow-up (PLTFU) of bacteriologically confirmed pulmonary tuberculosis (PTB) patients and its risk factors. DESIGN: A retrospective cohort study was conducted to retrieve information from the TB laboratory and treatment registers for all bacteriologically confirmed PTB patients diagnosed in the 39 DTUs during the last 6 months of 2015. PLTFU was defined as failure to initiate treatment within 7 days of diagnosis. RESULTS: Among 1174 bacteriologically confirmed PTB cases, the proportion of PLTFU was 16.7% (95%CI 14.7-18.9). In the multivariable logistic regression model, travelling >30 km to the DTU was a risk factor for PLTFU (adjusted odds ratio [aOR] 2.31, 95%CI 1.63-3.27) compared with travelling 30 km. Travelling for >30 min to the DTU (aOR 2.19, 95%CI 1.56-3.09) and an urban location of DTU (aOR 2.51, 95%CI 1.51-4.17) were also significant risk factors for PLTFU. CONCLUSION: PLTFU among TB patients remains a significant issue despite the availability of free anti-tuberculosis treatment in Cameroon. Diagnosed patients should be promptly and carefully linked to a treatment unit for treatment initiation.

Rifampicin resistance in new bacteriologically confirmed pulmonary tuberculosis patients in Cameroon: a cross-sectional survey.

OBJECTIVE: In Cameroon, tuberculosis (TB) cases are diagnosed and treated within a nationwide network of 248 diagnostic and treatment centres. In 2016, the centers notified a total of 175 multidrug-resistant (MDR-)TB cases, most of them retreatment cases. According to the WHO, the expected number of MDR-TB cases was estimated to be 1200 (1000-2200) corresponding to a rate of 6.8 (4.3-9.4) per 100,000 population. This indicates a notification gap of more than 80%. The objective of this study was to estimate the prevalence of MDR-TB in new bacteriologically confirmed pulmonary TB cases. We undertook a nationwide cross sectional survey during 6 weeks. RESULTS: During the study period, the NTP notified 1478 new bacteriologically confirmed pulmonary TB cases. Among them, 1029 (70%) had a valid Xpert result and 16 were identified with rifampicin resistant (RR-TB), a tracer of MDR-TB. This gives a prevalence of 1.6% (95% CI 0.8-2.3) among incident cases. The rate of RR-TB in the regions varied between 0 and 3.3%. If the results of this study are confirmed, the incidence rate given by WHO (2.8%, 95% CI 2.1-3.4) might be an over-estimation.

Treatment outcome with a short multidrug-resistant tuberculosis regimen in nine African countries.

SETTING: Nine countries in West and Central Africa. OBJECTIVE: To assess outcomes and adverse drug events of a standardised 9-month treatment regimen for multidrug-resistant tuberculosis (MDR-TB) among patients never previously treated with second-line drugs. DESIGN: Prospective observational study of MDR-TB patients treated with a standardised 9-month regimen including moxifloxacin, clofazimine, ethambutol (EMB) and pyrazinamide (PZA) throughout, supplemented by kanamycin, prothionamide and high-dose isoniazid during an intensive phase of a minimum of 4 to a maximum of 6 months. RESULTS: Among the 1006 MDR-TB patients included in the study, 200 (19.9%) were infected with the human immunodeficiency virus (HIV). Outcomes were as follows: 728 (72.4%) cured, 93 (9.2%) treatment completed (81.6% success), 59 (5.9%) failures, 78 (7.8%) deaths, 48 (4.8%) lost to follow-up. The proportion of deaths was much higher among HIV-infected patients (19.0% vs. 5.0%). Treatment success did not differ by HIV status among survivors. Fluoroquinolone resistance was the main cause of failure, while resistance to PZA, ethionamide or EMB did not influence bacteriological outcome. The most important adverse drug event was hearing impairment (11.4% severe deterioration after 4 months). CONCLUSIONS: The study results support the use of the short regimen recently recommended by the World Health Organization. Its high level of success even among HIV-positive patients promises substantial improvements in TB control.

Pulmonary tuberculosis in the Central Prison of Douala, Cameroon.

OBJECTIVE: To determine the prevalence of and factors associated with pulmonary tuberculosis (PTB) in an urban prison in sub-Saharan Africa. DESIGN: A cross-sectional survey. SETTING: The Central Prison of Douala, Cameroon. RESULTS: Two thousand four hundred and seventy four (87.4%) out of 2830 inmates underwent screening. Twenty seven (1.1%) of the inmates were under treatment for smear-positive PTB on commencement of the survey while 60 (2.4%) were diagnosed with smear and/or culture-positive PTB during the active case finding, resulting in a point prevalence of PTB of 3.5%. HIV seroprevalence in inmates without clinical signs of PTB was 111/1067 (10.4%) while it amounted to 6/24 (25%) in PTB patients. In multiple stepwise regression analysis, a low BMI, a prison stay of < or = 12 months, and a history of previous incarceration were positively associated with PTB. CONCLUSION: The study results confirm the high prevalence rates of PTB in prison populations and underscore the need for urgent preventive measures.

Routine use of antimicrobial drugs during the 2004 cholera epidemic in Douala, Cameroon.

OBJECTIVES: To evaluate routine use of antimicrobial drugs for treatment and prevention of cholera with special regards to the evolution of the antimicrobial drug resistance patterns of V. cholerae strains. DESIGN: Retrospective population-based descriptive study. SUBJECTS: Four thousand nine hundred and forty one notified cholera cases, their 15,381 patients' guards and their 159,263 household members and close neighbours. RESULTS: A total of 4,941 patients received antibiotic therapy according to the treatment protocols. Prophylactic treatment was administered to 15,381 patients' guards in hospitals and to 159,263 household members and close neighbours during home visits. Over the entire outbreak, the antimicrobial susceptibility patterns of V. cholerae strains isolated remained stable. CONCLUSIONS: The routine use of antimicrobial therapy for cholera cases associated with simultaneous and large scale chemoprophylaxis of close contacts does not seem in our experience to compromise the stability of V. cholerae susceptibility profiles to drugs when applied within a comprehensive package of rigorously monitored community interventions. The role of therapy and chemoprophylaxis in limiting the extent of a cholera epidemic is however difficult to ascertain from our experience. Field trials need to be designed to elucidate this aspect.

Clinical characteristics and outcomes of tuberculosis in Douala, Cameroon: a 7-year retrospective cohort study.

SETTING: Tuberculosis (TB) clinic, Douala Laquintinie Hospital, Douala, Cameroon. OBJECTIVE: To describe the clinical characteristics of TB and to investigate predictors of poor treatment outcomes. DESIGN: A registry-based, retrospective cohort study of all TB cases recorded from 2007 to 2013 was conducted. Multinomial logistic regression models were used to identify predictors of poor outcomes. RESULTS: Of 8902 TB cases included, 5110 (57.4%) were males. The median age was 33 years. The prevalence of human immunodeficiency virus (HIV) infection was 37.6%, with a significant decline over the study years (P = 0.000). The main clinical form of TB was smear-positive TB (50.5%). The treatment success rate was 75.2%, while the mortality rate was 8.1%. The year of TB diagnosis, retreatment cases, sputum non-conversion at the end of month 2, HIV infection and HIV testing not done were associated with death. Retreatment and non-conversion of sputum were associated with treatment failure, while male sex, age, sputum non-conversion, HIV infection and HIV testing not done were associated with loss to follow-up. CONCLUSION: TB management objectives may be attained by focusing specifically on higher risk groups to prevent poor treatment outcomes.

[Residual pleural opacity in patients treated for pleural tuberculosis in Yaounde]. / Opacité pleurale résiduelle en fin de traitement pour tuberculose pleurale à Yaoundé.

INTRODUCTION: The aim of this study was to evaluate the incidence and risk factors of residual pleural opacity (RPO) at the end and after 6 months (M12) of antituberculosis treatment (ATT) in adults with pleural tuberculosis. METHODS: In this prospective cohort study, all patients admitted for pleural tuberculosis between September 2010 and August 2012 in the pneumology A unit of Yaounde Jamot Hospital were included. Each patient was then followed up for 12 months. RPO was considered significant if it was measured 10mm or more on standard chest X-ray. The logistic regression model was used to investigate the risk factors of significant RPO at the end of antituberculosis treatment. RESULTS: Of the 193 patients included, median (interquartile range) age of 33 (25-42) years, 115 (59.6%) were men. The incidence (95% CI) of significant RPO was 22.0% (14.9-29.1) and 11.0% (4.9-17.1) at the end of ATT and at M12 respectively. In multivariate analysis, the risk factors of the occurrence of a significant RPO at the end of ATT and at M12 were smoking, associated parenchymal lesions, and hypoglycopleuria. CONCLUSION: Cumulative incidence of RPO ≥ 10 mm was 22% at the end of ATT and 11% after 12 months from the beginning of treatment. Patients with risk factors of RPO ≥ 10 mm should benefit from greater surveillance and appropriate management.

[Sensitization to Blomia tropicalis among asthmatic patients in Yaoundé, Cameroon]. / Sensibilisation à Blomia tropicalis chez les patients asthmatiques à Yaoundé, Cameroun.

INTRODUCTION: The aim of this study was to determine the prevalence and investigate associated factors for Blomia tropicalis (BT) sensitization in adolescent and adult patients with asthma in Yaoundé (Cameroon). METHODS: We performed a cross-sectional study of 18 months duration (January 2012 to June 2013). All asthmatic patients who were seen for a consultation during the study period and who had a skin prick testing for perennial aeroallergens were included in the study. RESULTS: Two hundred and one asthmatic patients (132 female patients, 65.7%) with median age (1st-3rd quartiles) of 35 (20-51.5) years were included in the study. Ninety-six (47.8%) patients had positive skin tests to BT. BT sensitization was associated with sensitization to two other dust mites (Dermatophagoides pteronyssinus [DP] and Dermatophagoides farinae [DF]) in 75 (86.2%) patients. The only clinical factor associated with BT sensitization was the presence of persistent rhinitis (odds ratio [confidence interval 95%]: 2.06 [1.12-3.81]). The independent allergenic factors associated with BT sensitization were sensitization to DP (3.49 [CI 95%: 1.49-8.19]), to DF (4.88 [CI 95%: 2.10-11.36]) and to German cockroach (4.16 [CI 95%: 1.72-10.09]). CONCLUSION: Blomia tropicalis sensitization is common in asthmatic patients in Yaoundé. It occurs most often in the context of sensitization to multiple aeroallergens, particularly with sensitization to other dust mites and German cockroach.

High effectiveness of a 12-month regimen for MDR-TB patients in Cameroon.

SETTING: Two specialised multidrug-resistant tuberculosis (MDR-TB) treatment units in Cameroon. OBJECTIVE: To assess outcome and adverse drug events with a standardised 12-month regimen for MDR-TB among second-line drug naïve patients. DESIGN: Prospective observational study of MDR-TB patients treated with a standardised 12-month regimen including gatifloxacin, clofazimine, prothionamide, ethambutol and pyrazinamide throughout, supplemented by kanamycin and isoniazid during an intensive phase of a minimum of 4 months. Progress was monitored monthly until treatment completion and twice over one year after treatment cessation. RESULTS: Eighty-seven potentially eligible patients were lost and never treated due to delayed availability of test results. Among the 150/236 eligible and treated patients, 134 (89%) successfully completed treatment, 10 died, 5 were lost, 1 failed and none relapsed. The patients' mean age was 33.7 years (range 17-68), 73 (49%) were females, 120 (80%) had failed on previous treatment, 30 (20%) were human immunodeficiency virus seropositive, 62 (43%) had a body mass index <18.5 kg/m(2) and 41 (27%) had radiographic involvement of five or six of the six lung zones. The most important adverse drug event was hearing impairment, which occurred in 46 of 106 (43%) patients. CONCLUSIONS: These results add further evidence for the usefulness of shorter, standardised regimens among patients without second-line drug resistance.

Initial resistance to antituberculosis drugs in Yaounde, Cameroon in 1995.

SETTING: Tuberculosis centre of Hôpital Jamot, Yaounde, Cameroon, the sole referral and tuberculosis treatment facility for Yaounde and its surroundings. OBJECTIVES: To identify Mycobacterium tuberculosis complex strains responsible for pulmonary tuberculosis in Yaounde, determine the prevalence of initial resistance to the main antituberculosis drugs and compare this prevalence in human immunodeficiency virus (HIV) positive and HIV-negative patients. DESIGN: In total, 576 consecutive and previously untreated adult patients admitted with sputum smear positive pulmonary tuberculosis to the tuberculosis centre from July 1994 to December 1995 were included in the study. Sputum specimens collected from each eligible patient were cultured on Löwenstein-Jensen and Coletsos media. Identification of the cultured strains was based on their cultural aspects and standard biochemical tests. The susceptibility of isolates to the major antituberculosis drugs was tested using the indirect proportion method. HIV testing was done using two ELISAs and confirmed by Western blot. RESULTS: Growth of M. tuberculosis complex strains was obtained from specimens of 516 (89.6%) of the 576 patients: 53 (10.3%) were identified as M. africanum and 463 (89.7%) as M. tuberculosis. Of the 516 patients with culture positive specimens, 92 (17.8%) were HIV-positive. Of the 516 strains isolated, 164 (31.8%) were resistant to at least one drug. The pattern of resistance was noted as 25% to one drug, 5.8% to two drugs and 1% to three or more drugs. Initial resistance to streptomycine was the most frequent (20.5%), followed by isoniazid (12.4%), thiacetazone (5.6%), rifampicin (0.8%) and ethambutol (0.4%). No significant difference in the rate of initial resistance was observed between HIV-positive and HIV-negative patients. CONCLUSION: The rate of initial drug resistance of M. tuberculosis in Yaounde is relatively high. There is therefore an urgent need to reestablish a tuberculosis control programme in Cameroon.

Are smear-positive pulmonary tuberculosis patients a 'sentinel' population for the HIV epidemic in Cameroon?

OBJECTIVE: To assess whether the human immunodeficiency virus (HIV) seroprevalence rate in adults with smear-positive pulmonary tuberculosis (PTB) can serve as a sentinel group for the estimation of HIV prevalence in the general adult population in Cameroon. DESIGN AND METHODS: A systematic review of reported HIV seroprevalence rates in the general adult population and in adults aged 15 years and over with PTB in Cameroon, using indexed and non indexed articles, publications, and reports from 1989 to 2000. Reconstruction of the evolution of the HIV seroprevalence in the two populations was done, and the relationship between these was established by the regression equation and the calculation of the correlation coefficient r. RESULTS: During the period 1989-2000, the evolution of HIV seroprevalence in the general adult population and in adults with PTB showed a steady increase, with a strong linear relationship (r = 0.96, df 7, P < 0.01). Each percentage increase of HIV seroprevalence among PTB patients corresponded to an increase of seroprevalence of about 0.3% in the general population. CONCLUSIONS: HIV seroprevalence in PTB patients in Cameroon could serve as a 'sentinel' for HIV seroprevalence in the general population.

Acquired anti-tuberculosis drug resistance in Yaounde, Cameroon.

SETTING: Tuberculosis centre of Hôpital Jamot, Yaounde, Cameroon. OBJECTIVES: To determine the prevalence of acquired resistance (ADR) to the main anti-tuberculosis drugs, and to identify risk factors associated with its occurrence in Yaounde. DESIGN: A total of 111 previously treated adults admitted consecutively to the tuberculosis centre with sputum smear-positive pulmonary tuberculosis between June 1996 and July 1997 were included in the study. Information on potential risk factors for ADR was obtained from each patient, and human immunodeficiency virus (HIV) serostatus was determined. Drug susceptibility testing to the main anti-tuberculosis drugs was performed on cultures of Mycobacterium tuberculosis complex isolated from sputum samples of each patient by the indirect proportion method. All patients whose isolates tested resistant to at least one anti-tuberculosis drug were defined as having ADR. RESULTS: Growth of M. tuberculosis complex was obtained from sputum specimens of 98 (88.3%) of the 111 patients studied; 57 (58.2%) of these were resistant to at least one anti-tuberculosis drug. Resistance to isoniazid was the most common (54.1%), followed by resistance to rifampicin (27.6%), streptomycin (25.5%) and ethambutol (12.2%). Multidrug resistance was observed in 27 (27.6%) of the cases. In a multivariate logistic regression analysis, ADR was significantly associated only with monotherapy use in previous tuberculosis treatment(s) (P = 0.03). CONCLUSION: The rate of ADR of M. tuberculosis is quite high in Yaounde. Acquired resistance to rifampicin alone or in combination with isoniazid is also high. Monotherapy in previous anti-tuberculosis treatment(s) is a significant predictor of ADR in previously treated patients in Yaounde. These results underscore the urgent need for the re-establishment of a tuberculosis control programme, using the DOTS strategy, in Cameroon.

Anti-tuberculosis drug resistance in the West Province of Cameroon.

SETTING: All 15 district hospitals of the West Province of Cameroon, between July 1997 and June 1998. OBJECTIVE: To determine the prevalences of initial and acquired resistance to the main anti-tuberculosis drugs 2 years after the implantation of a tuberculosis control programme in the province. METHODS: A total of 615 adults consecutively admitted to the 15 district hospitals with sputum smear-positive pulmonary tuberculosis were systematically studied. Sputum specimens collected from each patient were cultured on Lowenstein-Jensen medium. Testing of susceptibility to the major anti-tuberculosis drugs was performed by the indirect proportion method. RESULTS: Growth of Mycobacterium tuberculosis complex strains was obtained from specimens of 566 (92%) of the 615 patients. The overall resistance rate (one or more drugs) was 26.9%, with initial resistance being 19.7% (86/437) and acquired resistance 51.1% (66/129). Initial resistance to isoniazid was the most common (12.1%), followed by streptomycin (11.7%), ethambutol (2.5%) and rifampicin (2.1%). Initial resistance was noted as 13.5% to one drug, 4.3% to two, 1.1% to three and 0.7% to four. Acquired resistance to isoniazid was the most frequent (41.1%), followed by streptomycin (26.4%), rifampicin (14.7%) and ethambutol (9.3%). Acquired resistance was 25.6% to one drug, 14.7% to two, 7% to three and 3.9% to four. CONCLUSION: The proportion of resistant tuberculosis in the West Province is quite high. This underscores the need for the improvement of the control programme by introducing the DOTS strategy.