Prevalence and risk factors of multidrug-resistant tuberculosis in Cubal, Angola: a prospective cohort study

BACKGROUND: Although the Republic of Angola is one of the 14 countries figuring in the three high tuberculosis (TB) burden country lists, the true multi-drug-resistant TB (MDR-TB) situation is unknown. MATERIAL AND METHODS: Patients aged >= 16 years with a diagnosis of pulmonary TB were prospectively enrolled from June 2014 to July 2015. Sputum samples were collected for culture and drug susceptibility testing in all patients, and for Xpert (R) MTB/RIF testing in all previously treated patients and in new patients whose sputum remained smear-positive after 2 months of treatment. RESULTS: A total of 422 patients were included; Mycobacterium tuberculosis was isolated in 308 sputum samples. The prevalence of MDR-TB was 8.0% (18/225) in new patients and 71.1% (59/83) in previously treated patients. Male sex (OR 2.95, 95% CI 1.35-6.44, P = 0.007), previous anti-tuberculosis treatment (OR 20.86, 95% CI 9.53-45.67, P < 0.001), presence of pleural thickening (OR 7.68, 95% CI 1.57-37.43, P = 0.012) and duration of illness > 4 months (OR 3.34, 95% CI 1.45-7.69, P = 0.005) were independent risk factors for MDR-TB. CONCLUSIONS: The prevalence of MDR-TB in Cubal, Angola, was higher than estimated by the World Health Organization for Angola and one of the highest worldwide. Facilities to diagnose and treat MDR-TB are urgently needed in Angola.