Epidemiology of drug-susceptible, drug-resistant tuberculosis and HIV in Africa

Abstract

In Africa, TB-HIV co-infection rates are estimated to be 72%. Within sub-Saharan Africa, 34 countries recently reported patients with newly diagnosed MDR-TB, representing 14% of all emerging multi-drug resistant reports worldwide. In addition, eight African countries reported patients harboring extensively drug-resistant TB. More importantly, sub-Saharan Africa bears unacceptably high TB incidence rates coupled with the highest HIV prevalence rates globally. Occurrence of TB related death and new TB infections persist, with men disproportionately affected. A gradual reduction in TB incidence rates from 1.4% per annum between 2000 to 2017 to 1.9% per annum between 2015 and 2016 has been observed. Of note, eight out of the sixteen high burden African countries showed a sharp decline in TB incidence rates, surpassing the “End TB Strategy” goal of a 4% per annum decline. Additionally, substantial decreases in TB mortality in HIV infected patients in nine of sixteen high TB burden African countries were also observed. Programmatic uptake and scale up of TB screening, introduction of new TB diagnostic tests, TB preventive therapy and ART have collectively contributed to this success. Regardless of these improvements, TB remains Africa’s foremost cause of ill-health and death, with greater efforts required in curbing drug resistant TB incidence, poor drug resistant TB treatment outcomes, and in finding and treating missing TB patients.