By Institute of Medicine
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Extra resources for Addressing the Threat of Drug-Resistant Tuberculosis: A Realistic Assessment of the Challenge: Workshop Summary
Later, when transmission of drug resistance dominates most of those cases, the reported MDR TB rates will be higher. 21 THE GLOBAL SPREAD OF TUBERCULOSIS Cases per 100,000 population 400 350 Africa 300 Southeast Asia 250 World 200 Western Pacific 150 Eastern Mediterranean 100 Europe 50 Americas 19 9 19 0 91 19 9 19 2 9 19 3 94 19 9 19 5 96 19 9 19 7 9 19 8 9 20 9 00 20 0 20 1 0 20 2 03 20 0 20 4 0 20 5 06 0 Year FIGURE 2-2 Per capita incidence of TB. SOURCE: Nunn, 2008 (based on data from the WHO TB database, October 2008).
The formula used in map 3 suggests that, although Kenya’s last drug resistance survey was conducted in 1995 and the reported incidence was zero percent, a drug resistance survey conducted in Kenya today would not yield the same result. Methodological Problems The methodology used to conduct drug resistance surveys has a serious flaw that may result in underreporting. Current drug resistance surveys include only smear-positive TB cases, yet not all MDR TB cases are smear positive. In Latvia and the Ukraine, for example, where MDR TB rates are segregated on the basis of HIV status, it has been shown that there is a significant association between HIV positivity and MDR TB.
In Latvia and the Ukraine, for example, where MDR TB rates are segregated on the basis of HIV status, it has been shown that there is a significant association between HIV positivity and MDR TB. Furthermore, HIV-positive TB patients are more likely than other TB patients to be smear negative. Given the high prevalence of HIV in many parts of Africa, current drug resistance protocols may substantially underestimate MDR TB levels. Further underreporting may result from the fact that because MDR TB is underestimated in Africa, tools for its proper diagnosis in the region are not widely available.
Addressing the Threat of Drug-Resistant Tuberculosis: A Realistic Assessment of the Challenge: Workshop Summary by Institute of Medicine