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Journal of Clinical Microbiology, May 2009, p. 1484-1490, Vol. 47, No. 5
0095-1137/09/$08.00+0     doi:10.1128/JCM.02289-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

Potential of Rapid Diagnosis for Controlling Drug-Susceptible and Drug-Resistant Tuberculosis in Communities Where Mycobacterium tuberculosis Infections Are Highly Prevalent {triangledown}

Pieter W. Uys,1,2* Robin Warren,1 Paul D. van Helden,1 Megan Murray,3 and Thomas C. Victor1

MRC Center for Molecular and Cellular Biology, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Faculty of Health Sciences, Stellenbosch University, P.O. Box 19063, Tygerberg 7505, South Africa,1 DST/NRF Centre of Excellence for Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Western Cape, South Africa,2 PSOH, Harvard University, Cambridge, Massachusetts3

Received 28 November 2008/ Returned for modification 13 February 2009/ Accepted 4 March 2009

The long-term persistence of Mycobacterium tuberculosis in communities with high tuberculosis prevalence is a serious problem aggravated by the presence of drug-resistant tuberculosis strains. Drug resistance in an individual patient is often discovered only after a long delay, particularly if the diagnosis is based on current culture-based drug sensitivity testing methods. During such delays, the patient may transmit tuberculosis to his or her contacts. Rapid diagnosis of drug resistance would be expected to reduce this transmission and hence to decrease the prevalence of drug-resistant strains. To investigate this quantitatively, a mathematical model was constructed, assuming a homogeneous population structure typical of communities in South Africa where tuberculosis incidence is high. Computer simulations performed with this model showed that current control strategies will not halt the spread of multidrug-resistant tuberculosis in such communities. The simulations showed that the rapid diagnosis of drug resistance can be expected to reduce the incidence of drug-resistant cases provided the additional measure of screening within the community is implemented.

* Corresponding author. Mailing address: Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, Stellenbosch University, P.O. Box 19063, Tygerberg, 7505, South Africa. Phone: 27-83-5571151. Fax: 27-86-5140309. E-mail: pieter{at}edserve.co.za

{triangledown} Published ahead of print on 18 March 2009.

Journal of Clinical Microbiology, May 2009, p. 1484-1490, Vol. 47, No. 5
0095-1137/09/$08.00+0     doi:10.1128/JCM.02289-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.





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