|Institution:||Universiteit van Amsterdam|
|Full text PDF:||http://hdl.handle.net/11245/1.443854|
This thesis reports findings of six studies including two tuberculosis (TB) drug resistance surveys, a comparative study of HIV infection rates among patients enrolled in the survey and those under routine TB/HIV surveillance, two TB molecular epidemiological analyses and a systematic review and meta-analysis of drug-resistant TB in sub-Saharan Africa. It provides a general introduction to anti-tuberculosis drug resistance in the world and associated risk factors. Results from the drug resistance surveys presented show low levels of anti-TB drug resistance (DR) rates considering WHO estimates. Findings from these studies also indicated that anti-TB DR and HIV infection are not associated. From these studies we show consistently lower levels of TB/HIV co-infection among survey participants compared to what is reported under routine TB/HIV surveillance by the National TB/Leprosy Program. Through the molecular epidemiological studies, we confirm and document the predominant MTC lineages in Uganda and the negative association of the predominant lineage with TB DR. We explored anti-TB DR rates in relation to HIV infection elsewhere in sub-Saharan Africa through a systematic review. This analysis showed that pooled estimates of anti-TB DR including MDR-TB in this region are almost half of the global WHO estimates and that MDR-TB is not associated with HIV, despite TB/HIV co-infection rates being highest in this region. Finally, we discuss findings of the studies in general and policy implications to technically recommend to the national TB programs feasible interventions for prevention and control of DR-TB in this region.