A META-ANALYSIS OF DRUG RESISTANT TUBERCULOSIS IN SUB-SAHARAN AFRICA HOW STRONGLY ASSOCIATED WITH PREVIOUS TREATMENT AND HIV CO-INFECTION?

Abstract

BACKGROUND: In Sub-Saharan Africa, the fight against tuberculosis (TB) has encountered a greatchallenge because of the emergence of drug resistant TB strains and the high prevalence of HIVinfection. The aim of this meta-analysis was to determine the association of drug-resistant TB with anti-TB drug treatment history and HIV co-infection.METHODS: After electronic based literature search in the databases of Medline, HINARI, EMBASEand the Cochrane library, article selection and data extraction were carried out. HIV co-infection andprevious history of TB treatment were used as predictors for the occurrence of any anti-TB drug resistantor multiple drug resistant TB (MDR-TB). The risk ratios for each included study and for the pooledsample were computed using the random-effects model. Heterogeneity test, sensitivity analyses andfunnel plots were also done.RESULTS: The pooled analysis showed that the risk of developing drug-resistant TB to at least one anti-TB drug was about 3 times higher in individuals who had a previous history of anti-TB treatment thannew TB cases. The risk of having MDR-TB in previously anti-TB treated TB cases was more than 5-foldhigher than that of new TB cases. Resistance to Ethambutol and Rifampicin was more than fivefoldhigher among the previously treated with anti-TB drugs. However, HIV infection was not associated withdrug-resistant TB.CONCLUSION: There was a strong association of previous anti-TB treatment with MDR-TB. Primarytreatment warrants special emphasis, and screening for anti-TB drugs sensitivity has to be strengthened.