Screening outcomes from patients with suspected multidrug-resistant tuberculosis: lessons learned in the Philippines.

SETTING: The high prevalence of multidrug-resistant tuberculosis (MDR-TB) in the Philippines is a challenge for the National TB Programme. OBJECTIVE: To assess patterns of drug resistance and screening outcomes among MDR-TB suspects evaluated from 2003 to 2008 at DOTS-Plus clinics in the Philippines. METHODS: Descriptive study of 4897 consecutive patients with suspected MDR-TB. RESULTS: The median time from the first visit until a diagnosis of drug-resistant TB was 132 days (IQR 110-166 days). Among patients screened for MDR-TB, the most frequent resistance pattern among those previously treated in DOTS facilities was resistance to isoniazid (INH) and rifampicin (RMP). Resistance to INH+RMP plus fluoroquinolones was the most common pattern among those who had failed Category II treatment and patients treated by non-DOTS facilities. Among patients with MDR-TB, 57% ultimately received appropriate treatment with second-line drugs. The remaining 43% were lost to follow-up (25%), died (14%) or refused treatment (4%). CONCLUSION: Resistance to INH+RMP is the most frequent resistance pattern among patients referred from DOTS clinics in the Philippines for suspected MDR-TB. Initial use of standard regimens based on national survey data and quick uptake of new rapid molecular resistance tests may be useful to reduce diagnostic delays and expedite treatment for drug-resistant TB.

Measuring socio-economic data in tuberculosis prevalence surveys.

Addressing social determinants in the field of tuberculosis (TB) has received great attention in the past years, mainly due to the fact that worldwide TB incidence has not declined as much as expected, despite highly curative control strategies. One of the objectives of the World Health Organization Global Task Force on TB Impact Measurement is to assess the prevalence of TB disease in 22 high-burden countries by active screening of a random sample of the general population. These surveys provide a unique opportunity to assess socio-economic determinants in relation to prevalent TB and its risk factors. This article describes methods of measuring the socio-economic position in the context of a TB prevalence survey. An indirect measurement using an assets score is the most feasible way of doing this. Several examples are given from recently conducted prevalence surveys of the use of an assets score, its construction, and the analyses of the obtained data.

Multidrug-resistant tuberculosis among previously treated patients in the Philippines.

SETTING: Prior treatment has been associated with multidrug-resistant tuberculosis (MDR-TB) in many settings. The Philippines ranks fifth among 27 priority countries for MDR-TB. OBJECTIVE: To determine the rate of MDR-TB among previously treated patients referred for MDR screening and management. DESIGN: Descriptive study of the rate of MDR-TB among 4705 previously treated patients screened from 2003 to 2008. RESULTS: MDR-TB was present in 76% of 2438 screened patients who had positive cultures. The proportion of patients with MDR-TB was the same among patients referred from public or DOTS facilities and private or non-DOTS facilities. MDR-TB occurred most frequently among patients who failed treatment with the Category 2 regimen (97%), those who did not demonstrate culture conversion after 3 months of Category 2 treatment (91%), and Category 1 failures (83%). MDR-TB rates were respectively 78% and 57% for Category 2 relapse and return after default (RAD), and respectively 33% and 22% for Category 1 relapse and RAD. CONCLUSION: MDR-TB is frequent among previously treated patients in the Philippines. Screening with culture and drug susceptibility testing should be considered for these patients.

Significant decline in the tuberculosis burden in the Philippines ten years after initiating DOTS.

BACKGROUND: The Philippines ranks ninth among the 22 high-burden countries for tuberculosis (TB). OBJECTIVE: To measure the burden of pulmonary tuberculosis (PTB) in the Philippines and determine the impact of the DOTS strategy. MATERIALS AND METHODS: The 2007 nationwide TB prevalence survey covered 50 clusters selected by multi-stage stratified random sampling from Metro Manila and other urban and rural areas. Subjects aged >or=10 years were screened radiographically for PTB to identify subjects for sputum examination and determine the prevalence of bacteriologically confirmed PTB, i.e., smear- and/or culture-positive PTB. RESULTS: In subjects aged >or=10 years, the 2007 prevalence of radiographic PTB was 6.3% (95%CI 5.5-7.1), bacteriologically confirmed PTB was 6.6 per 1000 (95%CI 5.1-8.1) and sputum smear-positive PTB was 2.6/1000 (95%CI 1.7-3.6). For the total population, the corresponding estimates were respectively 4.7%, 4.9/1000 and 2.0/1000. Between 1997 and 2007, there was a 31% reduction in bacteriologically confirmed PTB (P < 0.02) and a 27% reduction in smear-positive PTB (P = 0.18). This decline occurred despite the increasing poverty in the population. CONCLUSION: The survey demonstrated a significant decline in the TB burden 10 years after the implementation of DOTS, facilitated by a strategic public-private partnership.