The epidemiology, transmission, diagnosis, and management of drug-resistant tuberculosis—lessons from the South African experience

Drug-resistant tuberculosis (DR-TB) threatens to derail tuberculosis control efforts, particularly in Africa where the disease remains out of control. The dogma that DR-TB epidemics are fueled by unchecked rates of acquired resistance in inadequately treated or non-adherent individuals is no longer...

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Published in:The Lancet infectious diseases Vol. 24; no. 9; pp. e559 - e575
Main Authors: Naidoo, Kogieleum, Perumal, Rubeshan, Cox, Helen, Mathema, Barun, Loveday, Marian, Ismail, Nazir, Omar, Shaheed Vally, Georghiou, Sophia B, Daftary, Amrita, O'Donnell, Max, Ndjeka, Norbert
Format: Journal Article
Language:English
Published: United States Elsevier Ltd 01.09.2024
Elsevier Limited
Subjects:
Antitubercular Agents - therapeutic use
COVID-19
Disease control
Disease resistance
Disease transmission
Drug resistance
Epidemics
Epidemiology
Humans
Innovations
Medical diagnosis
Medical innovations
Mycobacterium tuberculosis - drug effects
Pandemics
Patients
Poverty
Quality of life
South Africa - epidemiology
Tuberculosis
Tuberculosis, Multidrug-Resistant - diagnosis
Tuberculosis, Multidrug-Resistant - drug therapy
Tuberculosis, Multidrug-Resistant - epidemiology
Tuberculosis, Multidrug-Resistant - transmission
South Africa
Mozambique
Africa
ISSN:1473-3099, 1474-4457, 1474-4457
Online Access:Get full text
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Summary:Drug-resistant tuberculosis (DR-TB) threatens to derail tuberculosis control efforts, particularly in Africa where the disease remains out of control. The dogma that DR-TB epidemics are fueled by unchecked rates of acquired resistance in inadequately treated or non-adherent individuals is no longer valid in most high DR-TB burden settings, where community transmission is now widespread. A large burden of DR-TB in Africa remains undiagnosed due to inadequate access to diagnostic tools that simultaneously detect tuberculosis and screen for resistance. Furthermore, acquisition of drug resistance to new and repurposed drugs, for which diagnostic solutions are not yet available, presents a major challenge for the implementation of novel, all-oral, shortened (6–9 months) treatment. Structural challenges including poverty, stigma, and social distress disrupt engagement in care, promote poor treatment outcomes, and reduce the quality of life for people with DR-TB. We reflect on the lessons learnt from the South African experience in implementing state-of-the-art advances in diagnostic solutions, deploying recent innovations in pharmacotherapeutic approaches for rapid cure, understanding local transmission dynamics and implementing interventions to curtail DR-TB transmission, and in mitigating the catastrophic socioeconomic costs of DR-TB. We also highlight globally relevant and locally responsive research priorities for achieving DR-TB control in South Africa.
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ISSN:1473-3099
1474-4457
1474-4457
DOI:10.1016/S1473-3099(24)00144-0