Impact of Infection Control Measures to Control an Outbreak of Multidrug-Resistant Tuberculosis in a Human Immunodeficiency Virus Ward, Peru.

Abstract

Multidrug-resistant tuberculosis (MDRTB) rates in a human immunodeficiency virus (HIV) care facility increased by the year 2000-56% of TB cases, eight times the national MDRTB rate. We reported the effect of tuberculosis infection control measures that were introduced in 2001 and that consisted of 1) building a respiratory isolation ward with mechanical ventilation, 2) triage segregation of patients, 3) relocation of waiting room to outdoors, 4) rapid sputum smear microscopy, and 5) culture/drug-susceptibility testing with the microscopic-observation drug-susceptibility assay. Records pertaining to patients attending the study site between 1997 and 2004 were reviewed. Six hundred and fifty five HIV/TB-coinfected patients (mean age 33 years, 79% male) who attended the service during the study period were included. After the intervention, MDRTB rates declined to 20% of TB cases by the year 2004 (P = 0.01). Extremely limited access to antiretroviral therapy and specific MDRTB therapy did not change during this period, and concurrently, national MDRTB prevalence increased, implying that the infection control measures caused the fall in MDRTB rates. The infection control measures were estimated to have cost US$91,031 while preventing 97 MDRTB cases, potentially saving US$1,430,026. Thus, this intervention significantly reduced MDRTB within an HIV care facility in this resource-constrained setting and should be cost-effective.

• Authors: Eduardo Ticona, Luz Huaroto, Daniela E Kirwan, Milagros Chumpitaz, César V Munayco, Mónica Maguiña, Marco A Tovar, Carlton A Evans, Roderick Escombe, Robert H Gilman
• Journal: The American journal of tropical medicine and hygiene (Am J Trop Med Hyg) Vol. 95 Issue 6 Pg. 1247-1256 (Dec 07 2016) ISSN: 1476-1645 [Electronic] United States
• PMID: 27621303 (Publication Type: Journal Article)
• Copyright: © The American Society of Tropical Medicine and Hygiene.

Chemical References

• Antitubercular Agents

Topics

• Antitubercular Agents (therapeutic use)
• Costs and Cost Analysis
• Drug Resistance, Multiple, Bacterial
• HIV Infections (complications, epidemiology)
• Hospital Costs
• Humans
• Infection Control (economics, methods)
• Patient Isolation
• Peru (epidemiology)
• Retrospective Studies
• Tuberculosis, Multidrug-Resistant (epidemiology, prevention & control)