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Prospective Drug Resistance surveillance to determine prevalence and burden Multi-Drug resistance among smear positive cases in Bhutan

As per the Global TB Report 2013, 8.6 million new TB cases were detected in 2012 and 1.3 million TB deaths (around 1.0 million among HIV-negative people and 0.3 million HIV-associated TB deaths). Most of these TB cases and deaths occur among men but the burden of disease among women is also high. The South East Asia Region (SEAR) WHO region accounts for 38% of morbidity and 39% mortality of the Global burden of Tuberculosis, with an estimated 4.5 million prevalence and 3.4 million incidence and 440000 deaths in 2013. Five among 11 member countries in the SEARO region are among the 22 high TB burden countries in the world with India alone accounting for 23% of the world’s incidence and 21% of deaths for TB. Among all new TB cases detected in 2013 in the region, most cases occurred among young adults; age group 25-34 years and males are most affected compare to female with a male to female ratio of 1:5. (4)

In Bhutan, estimated TB prevalence and incidence rate of all forms of TB were 196 per 100,000 and 169 per 100000 population respectively in 2013. The notification rate of all forms of TB (new cases and relapses) and new bacteriologically confirmed cases were 143 per 100,000 and 56 per 100,000 population respectively. Treatment success for the cohort 2013 is 88% for new cases and 90% for all from of TB. The overall treatment success rate is maintained consistently above 90% since 2007.

The first TB drug resistance (DR) survey was conducted in 2010-2011 and since then TB drug resistance was conducted as surveillance because sample size require for survey as well as annual smear positive case reported amount to same number of smear positive cases require for representative of sample size for determining the drug resistance burden in the country. However, due to technical as well as logistic problem encountered in the past few previous years, lot of samples did not yield culture growth and complete drug susceptibility testing. As a result, samples with complete DST could not meet the minimum sample target to consider for analysis and interpretation. The objectives of the surveillance is to determine drug resistance and multi-drug resistance tuberculosis (MDR-TB) prevalence and MDR-TB burden among new and previously treated smear positive cases reported in 2014.