{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T03:40:53Z","timestamp":1774496453300,"version":"3.50.1"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2021,3,18]],"date-time":"2021-03-18T00:00:00Z","timestamp":1616025600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Commission via DEVCO","award":["SPHa\u00eftiLab project"],"award-info":[{"award-number":["SPHa\u00eftiLab project"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>Tuberculosis (TB) is the leading infectious cause of death in the world. Multi-drug resistant TB (MDR-TB) is a major public health problem as treatment is long, costly, and associated to poor outcomes. Here, we report epidemiological data on the prevalence of drug-resistant TB in Haiti.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This cross-sectional prevalence study was conducted in five health centers across Haiti. Adult, microbiologically confirmed pulmonary TB patients were included. Molecular genotyping (<jats:italic>rpoB<\/jats:italic> gene sequencing and spoligotyping) and phenotypic drug susceptibility testing were used to characterize rifampin-resistant MTB isolates detected by Xpert MTB\/RIF.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Between April 2016 and February 2018, 2,777 patients were diagnosed with pulmonary TB by Xpert MTB\/RIF screening and positive MTB cultures. A total of 74 (2.7%) patients were infected by a drug-resistant (DR-TB) <jats:italic>M<\/jats:italic>. <jats:italic>tuberculosis<\/jats:italic> strain. Overall HIV prevalence was 14.1%. Patients with HIV infection were at a significantly higher risk for infection with DR-TB strains compared to pan-susceptible strains (28.4% vs. 13.7%, adjusted odds ratio 2.6, 95% confidence interval 1.5\u20134.4, <jats:italic>P<\/jats:italic> = 0.001). Among the detected DR-TB strains, T1 (29.3%), LAM9 (13.3%), and H3 (10.7%) were the most frequent clades. In comparison with previous spoligotypes studies with data collected in 2000\u20132002 and in 2008\u20132009 on both sensitive and resistant strains of TB in Haiti, we observed a significant increase in the prevalence of the drug-resistant MTB Spoligo-International-Types (SIT) 137 (X2 clade: 8.1% vs. 0.3% in 2000\u201302 and 0.9% in 2008\u201309, p&lt;0.001), 5 (T1 clade: 6.8% vs 1.9 in 2000\u201302 and 1.7% in 2008\u201309, <jats:italic>P<\/jats:italic> = 0.034) and 455 (T1 clade: 5.4% vs 1.6% and 1.1%, <jats:italic>P<\/jats:italic> = 0.029). Newly detected spoligotypes (SIT 6, 7, 373, 909 and 1624) were also recorded.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>This study describes the genotypic and phenotypic characteristics of DR-TB strains circulating in Haiti from April 2016 to February 2018. Newly detected MTB clades harboring multi-drug resistance patterns among the Haitian population as well as the higher risk of MDR-TB infection in HIV-positive people highlights the epidemiological relevance of these surveillance data. The importance of detecting RIF-resistant patients, as proxy for MDR-TB in peripheral sites via molecular techniques, is particularly important to provide adequate patient case management, prevent the transmission of resistant strains in the community and to contribute to the surveillance of resistant strains.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0248707","type":"journal-article","created":{"date-parts":[[2021,3,18]],"date-time":"2021-03-18T17:50:41Z","timestamp":1616089841000},"page":"e0248707","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Drug-resistant TB prevalence study in 5 health institutions in Haiti"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2400-8862","authenticated-orcid":true,"given":"Jonathan","family":"Hoffmann","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carole","family":"Chedid","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oksana","family":"Ocheretina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chlo\u00e9","family":"Masetti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrice","family":"Joseph","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie-Marcelle","family":"Mabou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean Edouard","family":"Mathon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elie Maxime","family":"Francois","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juliane","family":"Gebelin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fran\u00e7ois-Xavier","family":"Babin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laurent","family":"Raskine","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean William","family":"Pape","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,3,18]]},"reference":[{"key":"pone.0248707.ref001","unstructured":"WHO | Global tuberculosis report 2019. In: WHO [Internet]. World Health Organization; [cited 25 May 2020]. http:\/\/www.who.int\/tb\/publications\/global_report\/en\/."},{"key":"pone.0248707.ref002","unstructured":"Center for Disease Control and Prevention. Global HIV and TB_Ha\u00efti country profile. 2018. https:\/\/www.cdc.gov\/globalhivtb\/where-we-work\/haiti\/haiti.html."},{"key":"pone.0248707.ref003","unstructured":"WHO | Tuberculosis country profiles. In: WHO [Internet]. [cited 4 Oct 2017]. http:\/\/www.who.int\/tb\/country\/data\/profiles\/en\/."},{"key":"pone.0248707.ref004","unstructured":"UNICEF. For Every Child, End AIDS, Seventh Stocktaking Report, 2016. 2016. https:\/\/www.unicef.org\/publications\/files\/Children_and_AIDS_Seventh_Stocktaking_Report_2016_EN.pdf.pdf."},{"key":"pone.0248707.ref005","doi-asserted-by":"crossref","first-page":"103","DOI":"10.5588\/pha.18.0021","article-title":"Outcomes across the tuberculosis care continuum among adolescents in Haiti","volume":"8","author":"LK Reif","year":"2018","journal-title":"Public Health Action"},{"key":"pone.0248707.ref006","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1590\/S1020-49892012000300006","article-title":"Multidrug-resistant tuberculosis in Port-au-Prince, Haiti","volume":"31","author":"O Ocheretina","year":"2012","journal-title":"Rev Panam Salud Publica"},{"key":"pone.0248707.ref007","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1097\/01.aids.0000206505.09159.9a","article-title":"Multidrug-resistant tuberculosis at an HIV testing center in Haiti","volume":"20","author":"P Joseph","year":"2006","journal-title":"AIDS"},{"key":"pone.0248707.ref008","unstructured":"WHO | WHO consolidated guidelines on drug-resistant tuberculosis treatment. In: WHO [Internet]. World Health Organization; [cited 25 May 2020]. http:\/\/www.who.int\/tb\/publications\/2019\/consolidated-guidelines-drug-resistant-TB-treatment\/en\/."},{"key":"pone.0248707.ref009","unstructured":"Minist\u00e8re de la sant\u00e9 publique et de la population, R\u00e9publique d\u2019Ha\u00efti. Rapport statistique 2018. 2019. https:\/\/mspp.gouv.ht\/site\/downloads\/Rapport%20Statistique%20MSPP%202018%20version%20web.pdf."},{"key":"pone.0248707.ref010","doi-asserted-by":"crossref","first-page":"715","DOI":"10.4269\/ajtmh.14-0161","article-title":"Treatment outcomes for patients with multidrug-resistant tuberculosis in post-earthquake Port-au-Prince, Haiti","volume":"91","author":"M Charles","year":"2014","journal-title":"Am J Trop Med Hyg"},{"key":"pone.0248707.ref011","unstructured":"Minist\u00e8re de la Sant\u00e9 publique et de la Population. Programme National de Lutte contre la Tuberculose (PNLT): manuel de normes de la tuberculose en Haiti. 2010. https:\/\/mspp.gouv.ht\/site\/downloads\/Manuel%20de%20normes%20PNLT.pdf."},{"key":"pone.0248707.ref012","doi-asserted-by":"crossref","first-page":"e90569","DOI":"10.1371\/journal.pone.0090569","article-title":"Correlation between Genotypic and Phenotypic Testing for Resistance to Rifampin in Mycobacterium tuberculosis Clinical Isolates in Haiti: Investigation of Cases with Discrepant Susceptibility Results","volume":"9","author":"O Ocheretina","year":"2014","journal-title":"PLOS ONE"},{"key":"pone.0248707.ref013","doi-asserted-by":"crossref","first-page":"2232","DOI":"10.1128\/JCM.00268-13","article-title":"Use of Luminex MagPlex Magnetic Microspheres for High-Throughput Spoligotyping of Mycobacterium tuberculosis Isolates in Port-au-Prince, Haiti","volume":"51","author":"O Ocheretina","year":"2013","journal-title":"Journal of Clinical Microbiology"},{"key":"pone.0248707.ref014","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.meegid.2018.12.030","article-title":"Macro-geographical specificities of the prevailing tuberculosis epidemic as seen through SITVIT2, an updated version of the Mycobacterium tuberculosis genotyping database","volume":"72","author":"D Couvin","year":"2019","journal-title":"Infection, Genetics and Evolution"},{"key":"pone.0248707.ref015","doi-asserted-by":"crossref","first-page":"152","DOI":"10.5395\/rde.2017.42.2.152","article-title":"Statistical notes for clinical researchers: Chi-squared test and Fisher\u2019s exact test","volume":"42","author":"H-Y Kim","year":"2017","journal-title":"Restorative Dentistry & Endodontics"},{"key":"pone.0248707.ref016","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1080\/00401706.1964.10490181","article-title":"Multiple Comparisons Using Rank Sums","volume":"6","author":"OJ Dunn","year":"1964","journal-title":"Technometrics"},{"key":"pone.0248707.ref017","unstructured":"Center for Disease Control. Haiti Country Profile. 27 Aug 2019 [cited 26 May 2020]. https:\/\/www.cdc.gov\/globalhivtb\/where-we-work\/haiti\/haiti.html."},{"key":"pone.0248707.ref018","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1086\/514084","article-title":"Nosocomial spread of human immunodeficiency virus-related multidrug-resistant tuberculosis in Buenos Aires","volume":"176","author":"V Ritacco","year":"1997","journal-title":"J Infect Dis"},{"key":"pone.0248707.ref019","doi-asserted-by":"crossref","DOI":"10.7554\/eLife.16644","article-title":"Impact of HIV co-infection on the evolution and transmission of multidrug-resistant tuberculosis","volume":"5","author":"V Eldholm","year":"2016","journal-title":"Elife"},{"key":"pone.0248707.ref020","doi-asserted-by":"crossref","first-page":"e5561","DOI":"10.1371\/journal.pone.0005561","article-title":"Is HIV infection a risk factor for multi-drug resistant tuberculosis? A systematic review","volume":"4","author":"S Suchindran","year":"2009","journal-title":"PLoS ONE"},{"key":"pone.0248707.ref021","doi-asserted-by":"crossref","first-page":"e0129207","DOI":"10.1371\/journal.pone.0129207","article-title":"Whole Genome Sequencing Investigation of a Tuberculosis Outbreak in Port-au-Prince, Haiti Caused by a Strain with a \u201cLow-Level\u201d rpoB Mutation L511P\u2014Insights into a Mechanism of Resistance Escalation","volume":"10","author":"O Ocheretina","year":"2015","journal-title":"PLOS ONE"},{"key":"pone.0248707.ref022","first-page":"2014","article-title":"A First Assessment of Mycobacterium tuberculosis Genetic Diversity and Drug-Resistance Patterns in Twelve Caribbean Territories","author":"J Millet","year":"2014","journal-title":"Biomed Res Int"},{"key":"pone.0248707.ref023","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.5588\/ijtld.17.0049","article-title":"Diagnostic yield of active case finding for tuberculosis and HIV at the household level in slums in Haiti","volume":"21","author":"VR Rivera","year":"2017","journal-title":"Int J Tuberc Lung Dis"},{"key":"pone.0248707.ref024","doi-asserted-by":"crossref","first-page":"433","DOI":"10.4269\/ajtmh.16-0674","article-title":"Active Tuberculosis Case Finding in Haiti","volume":"97","author":"J Masur","year":"2017","journal-title":"Am J Trop Med Hyg"},{"key":"pone.0248707.ref025","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.5588\/ijtld.18.0835","article-title":"Diagnostic yield of active case finding for tuberculosis at human immunodeficiency virus testing in Haiti","volume":"23","author":"VR Rivera","year":"2019","journal-title":"Int J Tuberc Lung Dis"},{"key":"pone.0248707.ref026","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1093\/cid\/ciz039","article-title":"Improved Outcomes With High-dose Isoniazid in Multidrug-resistant Tuberculosis Treatment in Haiti","volume":"69","author":"KF Walsh","year":"2019","journal-title":"Clin Infect Dis"},{"key":"pone.0248707.ref027","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1016\/S0140-6736(18)31644-1","article-title":"Treatment correlates of successful outcomes in pulmonary multidrug-resistant tuberculosis: an individual patient data meta-analysis","volume":"392","author":"N Ahmad","year":"2018","journal-title":"The Lancet"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0248707","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,18]],"date-time":"2021-03-18T17:51:36Z","timestamp":1616089896000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0248707"}},"subtitle":[],"editor":[{"given":"Shampa","family":"Anupurba","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,3,18]]},"references-count":27,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0248707","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,18]]}}}