{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T19:49:10Z","timestamp":1790192950872,"version":"4.1.0"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,11,22]],"date-time":"2021-11-22T00:00:00Z","timestamp":1637539200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,11,22]],"date-time":"2021-11-22T00:00:00Z","timestamp":1637539200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Africa-ai-Japan","award":["JKU\/ADM\/10B"],"award-info":[{"award-number":["JKU\/ADM\/10B"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>Globally anti-tuberculosis drug resistance is one of the major challenges affecting control and prevention of tuberculosis. Kenya is ranked among 30 high burden TB countries globally. However, there is scanty information on second line antituberculosis drug resistance among tuberculosis patients. Therefore, this study aimed at determining <jats:italic>Mycobacterium tuberculosis<\/jats:italic> drug resistant strain distribution pattern in 10 counties of Western Kenya among HIV positive and negative patients.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Method<\/jats:title>\n                <jats:p>A cross-sectional study was conducted in Western Kenya, which comprises 10 counties. A multistage sampling method was used where a single sub-county was randomly selected followed by sampling one high volume health facility from each sub-county. Consenting study subjects with at least two smear positive sputum at the time of enrolment were randomly selected. The collected sputum was decontaminated with <jats:italic>N<\/jats:italic>-acetyl-<jats:sc>l<\/jats:sc>-cysteine-sodium hydroxide (NALC-NaOH) and then stained with Ziehl Neelsen Stain before visualizing the presence of bacilli under microscope at \u00d7100 magnification with oil immersion. Further, the identified bacilli were cultured and susceptibility test carried out using known first and second line antimycobacterial tuberculosis. HIV testing was carried out using Determine<jats:sup>\u00ae<\/jats:sup> HIV-1\/2 rapid test (Abbot Diagnostics, Maidenhead, United Kingdom). Those who had smear converted were dropped from the study. Finally, drug susceptibility pattern across the 10 counties of Western Kenya was evaluated.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Our study showed that <jats:italic>Mycobacterium tuberculosis<\/jats:italic> drug resistance among HIV negative and positive cases in Western Kenya was prevalent in all the 10 counties surveyed. Based on the drug susceptibility tests, 53.2% and 42.7% of the study samples were resistant to at least one antituberculosis drug among HIV negative and HIV positive patients respectively. The data analysis revealed that among the HIV-positive and HIV-negative patients, resistance to INH was predominant (28.5%, and 23.6%, respectively), followed by RIF (16.4% and 14.6% respectively). Second-line drug resistant strains identified among HIV negative patients included Ethionamide (0.3%), Gatifloxacin (0.3%), Amikacin (0.3%) and Capreomycin (0.3%). There was no second line drug monoresistance among HIV positive TB patients. Multi\/poly drug resistance were noted among HIV-negative patients in, INH\u2009+\u2009AMK (0.7%), INH\u2009+\u2009PZA (1%), INH\u2009+\u2009GFX (0.7%, INH\u2009+\u2009ETO (0.7%, STY\u2009+\u2009ETO (1%), ETH\u2009+\u2009ETO (1.0%), INH\u2009+\u2009KAN (0.7%) and INH\u2009+\u2009CAP (0.7%) strains\/cases at 95% confidence interval. Among HIV positive patients INH\u2009+\u2009GFX (1.1%), INH\u2009+\u2009ETO (0.4%) and INH\u2009+\u2009KAN (0.4%) strains of <jats:italic>M. tuberculosis<\/jats:italic> were identified with a confidence interval of 95%. Geographical distribution patterns analysis of <jats:italic>M. tuberculosis<\/jats:italic> drug polyresistant strains across the 10 counties were recorded. Among HIV TB patients, resistant strains were identified in Nyamira (INH\u2009+\u2009GFX, INH\u2009+\u2009KAN), Bungoma ((ETO\u2009+\u2009STY), Busia (ETH\u2009+\u2009ETO and STY\u2009+\u2009ETO) Homabay (RIF\u2009+\u2009AMK. ETO\u2009+\u2009ETH and ETO\u2009+\u2009STY), Kisumu (ETH\u2009+\u2009ETO and PZA\u2009+\u2009ETO) and in Kakamega, Kisii and Vihiga (INH\u2009+\u2009KAN and RIF\u2009+\u2009AMK). There was no <jats:italic>M. tuberculosis<\/jats:italic> polyresistant strain identified in Migori and Siaya counties. Among HIV positive TB patients, M. tuberculosis resistant strains were identified in three counties, Nyamira (INH\u2009+\u2009KAN) Homabay (INH\u2009+\u2009GFX and INH\u2009+\u2009AMK) and Kakamega (INH\u2009+\u2009GFX). There was no polyresistant <jats:italic>M. tuberculosis<\/jats:italic> strain identified in Migori, Bungoma, Kisii, Vihiga, Busia, Siaya and Kisumu Counties.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Discussion<\/jats:title>\n                <jats:p>The distribution patterns of <jats:italic>M. tuberculosis<\/jats:italic> drug resistance among HIV negative and positive TB patients could be as a result of reported high prevalence of HIV in Western Kenya counties especially the area under study. Tuberculosis is one of the opportunistic diseases that have been shown to be the major cause of AIDS among HIV infected patients. Resent reports by National AIDS Control Council shows that Kisumu, Siaya, Homabay, Migori, Busia have the overall leading in HIV prevalence in Kenya. The low prevalence of drug resistant strains among HIV tuberculosis patients could be as a result of drug adherence attitude adopted by HIV patients, availability of continuous counselling and close follow up and notification by healthcare workers and community health volunteers.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Drug resistant <jats:italic>M. tuberculosis<\/jats:italic> strains prevalence is still high among HIV negative and positive patients in Western Kenya with the most affected being HIV negative TB patients. It is therefore probable that the existing control measures are not adequate to control transmission of drug resistant strains. Further, miss diagnosis or delayed diagnosis of TB patients could be contributing to the emergence of <jats:italic>M. tuberculosis<\/jats:italic> drug polyresistant strains.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Recommendation<\/jats:title>\n                <jats:p>Based on the result of this study, regular TB drug resistance surveillance should be conducted to ensure targeted interventions aimed at controlling increased transmission of the tuberculosis drug resistant strains among HIV\/AIDS and HIV negative patients. There is also need for improved drug resistant infection control measures, timely and rapid diagnosis and enhanced and active screening strategies of tuberculosis among suspected TB patients need to be put in place. Further, studies using a larger patient cohort and from counties across the country would shed much needed insights on the true national prevalence of different variants of <jats:italic>M. tuberculosis<\/jats:italic> drug resistance.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12879-021-06887-x","type":"journal-article","created":{"date-parts":[[2021,11,22]],"date-time":"2021-11-22T12:02:52Z","timestamp":1637582572000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Distribution patterns of drug resistance Mycobacterium tuberculosis among HIV negative and positive tuberculosis patients in Western Kenya"],"prefix":"10.1186","volume":"21","author":[{"given":"Martin O.","family":"Ogwang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mabel","family":"Imbuga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Ngugi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy","family":"Mutharia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Magoma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lamec","family":"Diero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,11,22]]},"reference":[{"issue":"5","key":"6887_CR1","doi-asserted-by":"publisher","first-page":"e38080","DOI":"10.1371\/journal.pone.0038080","volume":"7","author":"G Sandhu","year":"2012","unstructured":"Sandhu G, et al. 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All participants in the study were taken through the study objectives allowed to seek clarification. It was also made clear to them that they were free to opt out at any point of the study. Those who agreed to participate were then allowed to confirm their willingness to participate out of free will through signing the informed consent or use of thumb print. All procedures in the manuscript were performed in accordance with relevant guidelines.Administrative permissions were acquired by our team to access the data used in this paper from the Division of Tuberculosis, Leprosy and Lung Diseases, a Division of the Ministry of Health. P.O. Box 20781 - 00202 Nairobi, Kenya. Tel: +\u2009(254) 773 977 440.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"All authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1175"}}