ArticlesEpidemiology of antituberculosis drug resistance 2002–07: an updated analysis of the Global Project on Anti-Tuberculosis Drug Resistance Surveillance
Introduction
The Global Project on Anti-Tuberculosis Drug Resistance Surveillance was initiated in 1994 to estimate the burden of drug-resistant tuberculosis worldwide. The project's primary aims are to monitor trends in resistance and estimate the prevalence of multidrug-resistant (MDR) tuberculosis. Countries that participate in the project follow standardised guidelines for data collection to ensure comparability both between and within countries. The report is published approximately every 3 years since most countries need around 18 months to complete a drug resistance survey.
Until 2000, few national tuberculosis programmes were diagnosing and managing drug-resistant tuberculosis cases in the public sector, with the exception of high-income countries and countries of the former Soviet Union. After the successful implementation of pilot projects to manage drug-resistant tuberculosis, the new Stop TB Strategy—which expands on the directly observed treatment, short-course strategy (DOTS)—was launched in 2006. The Stop TB Strategy includes the diagnosis and management of drug-resistant tuberculosis as one of its components and underpins the Second Global Plan to Stop TB 2006–2015, which provides targets and financial estimates for scale-up of the strategy.1 Nowadays, with the support of the Green Light Committee and other technical and financial partners, many countries are initiating or expanding the diagnosis and management of drug-resistant tuberculosis.
This report provides the latest data on the extent of antituberculosis drug resistance in 83 countries and territories gathered between 2002 and 2007, including the magnitude of extensively drug-resistant (XDR) tuberculosis,2 and an analysis of the association between HIV and drug-resistant tuberculosis. Data gathered since 1994, from 115 countries, are used to explore trends in resistance. On the basis of such empirical information, new estimates of the global and regional burden of MDR tuberculosis are presented.
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Data collection
A detailed description of the methods of the Global Project can be found in the full report and surveillance guidelines.3, 4, 5, 6 Briefly, the surveys are done on the basis of three main principles: the sample of tuberculosis patients must be representative of all cases of tuberculosis in the geographical setting under assessment; drug resistance must be distinguished according to the treatment history of the patient (ie, never treated or previously treated); and laboratory results must be
Results
The fourth round of the Global Project includes data from 83 countries and territories that provided at least one data point since 2002. Two settings in India completed drug resistance surveys in 2001. We have reported these data in the tables; however, they have been excluded from the analyses. Worldwide, 90 726 tuberculosis cases (consisting of new cases, previously treated cases, and those with an unknown history of previous treatment) were tested for antituberculosis drug resistance. Nine
Discussion
Data from our global survey show regional and national variation in the magnitude and trends in drug-resistant tuberculosis. Countries of the former Soviet Union, followed by some provinces of China, reported the highest prevalence of resistance, while the eastern Mediterranean region and southeast Asia reported prevalence of resistance on par with estimated global averages. The data presented here show that of the half a million MDR-tuberculosis cases estimated to have emerged in 2006, 50%
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