Academic literature on the topic 'Tuberculosis – Botswana'
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Journal articles on the topic "Tuberculosis – Botswana"
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Bonora, S., M. Boffito, S. Audagnotto, et al. "Tuberculosis Transmission in Botswana." Journal of Clinical Microbiology 39, no. 10 (2001): 3815–16. http://dx.doi.org/10.1128/jcm.39.10.3815-3816.2001.
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Mogashoa, Tuelo, Lucy Mupfumi, Thato Iketleng, et al. "PO 8408 DETECTION OF EXTENSIVELY DRUG-RESISTANT TUBERCULOSIS AMONG MULTIDRUG-RESISTANT MYCOBACTERIUM TUBERCULOSIS CLINICAL ISOLATES IN BOTSWANA." BMJ Global Health 4, Suppl 3 (2019): A33.1—A33. http://dx.doi.org/10.1136/bmjgh-2019-edc.85.
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BackgroundThe emergence and transmission of multidrug-resistant (MDR) and extensively drug-resistant (XDR) Mycobacterium tuberculosis (Mtb) strains is a serious threat to tuberculosis control in Botswana. Early detection of drug-resistant isolates is critical to ensure optimal treatment and thereby improve treatment outcomes. The objective of this study was to determine the extent of second-line drug resistance among drug-resistant Mtb-isolates from Botswana.MethodsA total of 60 drug-resistant Mtb isolates received at Botswana National Tuberculosis Reference Laboratory between 2012 and 2013 were analysed. DNA was extracted from BD Mycobacterial Growth Indicator Tubes (MGIT) using GenoLyse DNA isolation kit (Hain Lifescience). Spoligotyping was done using a commercially available spoligotyping kit (Isogen Life Science). The spoligotype patterns were compared with existing patterns in the SITVIT2 Web database. GenoType MTBDRs assay (Hain Lifescience) was used for second-line drug susceptibility testing. Fisher’s exact test was used to test for association between drug resistance patterns and HIV status, lineage and geographical location.ResultsSeventeen distinct spoligotype patterns were detected amongst the 60 drug-resistant isolates. The most predominant lineages were Euro-American (58.3%), East Asian (25%) and Indo-Oceanic (15%). Fifty (83.3%) were MDR, 7 (11.7%) were resistant to fluoroquinolones (Pre-XDR) whereas 3 (5%) were resistant to both fluoroquinolones and second-line injectable drugs (XDR). Drug resistance profiles were significantly associated with Mtb lineage (p<0.001). There was no association between drug resistance profile and HIV status (p=0.057) and geographical location (p=0.372).ConclusionThis study highlights the importance of including second-line drug susceptibility testing in a testing algorithm in Botswana. The detection of XDR isolates among MDR-TB isolates highlights the ongoing evolution of resistance and the need for strengthened treatment regimens to improve treatment outcomes and to prevent the spread of these highly resistant strains. Second-line testing will be essential if the 9 month MDR regimen is used in Botswana.
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Kumaresan, J. A., and E. T. Maganu. "Case holding in patients with tuberculosis in Botswana." BMJ 305, no. 6849 (1992): 340–41. http://dx.doi.org/10.1136/bmj.305.6849.340.
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Mogashoa, Tuelo, Pinkie Melamu, Serej D. Ley, et al. "Genetic diversity of Mycobacterium tuberculosis strains circulating in Botswana." PLOS ONE 14, no. 5 (2019): e0216306. http://dx.doi.org/10.1371/journal.pone.0216306.
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Talbot, Elizabeth A., Thomas A. Kenyon, Themba L. Moeti, et al. "HIV risk factors among patients with tuberculosis — Botswana 1999." International Journal of STD & AIDS 13, no. 5 (2002): 311–17. http://dx.doi.org/10.1258/0956462021925126.
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To identify factors associated with HIV in Botswana, a standardized questionnaire was administered to 135 tuberculosis patients with known HIV status. HIV-positive patients were more likely than HIV-negative patients to: be female (45% vs 26% (adjusted prevalence odds ratio (aPOR)=3.8, 95% confidence interval (CI)=1.1-12.7)); be 26-35 years old (50% vs 19% (aPOR=2.7, CI=0.7-10.7)); be unmarried (91% vs 71% (aPOR=13.3, CI=2.5-72.7)); have higher income (24% vs 10% (aPOR=8.2, CI=1.6-42.9)); report separation from spouse/partner for work (63% vs 52% (aPOR=1.8, CI=0.5-6.2)); have 2 sex partners other than their regular partner (82% vs 67% (aPOR=1.8, CI=0.5-7.5)); and state that they or their partner drank alcohol before sex (77% vs 55% (aPOR=6.8, CI=1.9-24.1)). Only 22% of respondents used condoms during all of their past 10 sexual encounters. These data provide information for HIV prevention strategies.
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Reid, Michael J. A., Aderonke Oyewo, Bodney Molosiwa, Nikia McFadden, Billy Tsima, and Ari Ho-Foster. "Screening for tuberculosis in a diabetes clinic in Gaborone, Botswana." International Journal of Tuberculosis and Lung Disease 18, no. 8 (2014): 1004. http://dx.doi.org/10.5588/ijtld.14.0178.
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Enane, L. A., E. D. Lowenthal, T. Arscott-Mills, et al. "Loss to follow-up among adolescents with tuberculosis in Gaborone, Botswana." International Journal of Tuberculosis and Lung Disease 20, no. 10 (2016): 1320–25. http://dx.doi.org/10.5588/ijtld.16.0060.
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Mulale, Unami Koolebogile, Thanolo Kashamba, Jonathan Strysko, and Lynnette Tumwine Kyokunda. "Fatal SARS-CoV-2 and Mycobacterium tuberculosis coinfection in an infant: insights from Botswana." BMJ Case Reports 14, no. 4 (2021): e239701. http://dx.doi.org/10.1136/bcr-2020-239701.
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We report a fatal case of SARS-CoV-2 and Mycobacterium tuberculosis coinfection in an infant, Botswana’s first paediatric COVID-19-associated fatality. The patient, a 3-month-old HIV-unexposed boy, presented with fever and respiratory distress in the setting of failure to thrive. Both the patient and his mother tested positive for rifampin-sensitive M. tuberculosis (Xpert MTB/Rif) and SARS-CoV-2 (real time-PCR). Initially stable on supplemental oxygen and antitubercular therapy, the patient experienced precipitous clinical decline 5 days after presentation and subsequently died. Autopsy identified evidence of disseminated tuberculosis (TB) as well as histopathological findings similar to those described in recent reports of SARS-CoV-2 infections, including diffuse microthrombosis. TB remains a serious public health threat in hyperendemic regions like sub-Saharan Africa, and is often diagnosed late in infants. In addition to raising the question of additive/synergistic pathophysiology and/or immune reconstitution, this case of coinfection also highlights the importance of leveraging the COVID-19 pandemic response to strengthen efforts for TB prevention, screening and detection.
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Mogashoa, Tuelo, Pinkie Melamu, Brigitta Derendinger, et al. "Detection of Second Line Drug Resistance among Drug Resistant Mycobacterium Tuberculosis Isolates in Botswana." Pathogens 8, no. 4 (2019): 208. http://dx.doi.org/10.3390/pathogens8040208.
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The emergence and transmission of multidrug resistant (MDR) and extensively drug resistant (XDR) Mycobacterium tuberculosis (M.tb) strains is a threat to global tuberculosis (TB) control. The early detection of drug resistance is critical for patient management. The aim of this study was to determine the proportion of isolates with additional second-line resistance among rifampicin and isoniazid resistant and MDR-TB isolates. A total of 66 M.tb isolates received at the National Tuberculosis Reference Laboratory between March 2012 and October 2013 with resistance to isoniazid, rifampicin or both were analyzed in this study. The genotypes of the M.tb isolates were determined by spoligotyping and second-line drug susceptibility testing was done using the Hain Genotype MTBDRsl line probe assay version 2.0. The treatment outcomes were defined according to the Botswana national and World Health Organization (WHO) guidelines. Of the 57 isolates analyzed, 33 (58%) were MDR-TB, 4 (7%) were additionally resistant to flouroquinolones and 3 (5%) were resistant to both fluoroquinolones and second-line injectable drugs. The most common fluoroquinolone resistance-conferring mutation detected was gyrA A90V. All XDR-TB cases remained smear or culture positive throughout the treatment. Our study findings indicate the importance of monitoring drug resistant TB cases to ensure rapid detection of second-line drug resistance.
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Agizew, T., D. Surie, J. E. Oeltmann, et al. "Tuberculosis preventive treatment opportunities at antiretroviral therapy initiation and follow-up visits." Public Health Action 10, no. 2 (2020): 64–69. http://dx.doi.org/10.5588/pha.19.0056.
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Setting: Twenty-two clinics providing HIV care and treatment in Botswana where tuberculosis (TB) and HIV comorbidity is as high as 49%.Objectives: To assess eligibility of TB preventive treatment (TPT) at antiretroviral therapy (ART) initiation and at four follow-up visits (FUVs), and to describe the TB prevalence and associated factors at baseline and yield of TB diagnoses at each FUV.Design: A prospective study of routinely collected data on people living with HIV (PLHIV) enrolled into care for the Xpert® MTB/RIF Package Rollout Evaluation Study between 2012 and 2015.Results: Of 6041 PLHIV initiating ART, eligibility for TPT was 69% (4177/6041) at baseline and 93% (5408/5815); 95% (5234/5514); 96% (4869/5079); and 97% (3925/4055) at FUV1, FUV2, FUV3, and FUV4, respectively. TB prevalence at baseline was 11% and 2%, 3%, 3% and 6% at each subsequent FUV. At baseline, independent risk factors for prevalent TB were CD4 <200 cells/mm3 (aOR = 1.4, P = 0.030); anemia (aOR = 2.39, P < 0.001); cough (aOR = 11.21, P < 0.001); fever (aOR = 2.15, P = 0.001); and weight loss (aOR = 2.60, P = 0.002).Conclusion: Eligibility for TPT initiation is higher at visits post-ART initiation, while most cases of active TB were identified at ART initiation. Missed opportunities for TB further compromises TB control effort among PLHIV in Botswana.
Dissertations / Theses on the topic "Tuberculosis – Botswana"
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Tumelo, Sylvia Mmamoseka 1953. "COMPLIANCE AND FAMILY INVOLVEMENT WITH TUBERCULOSIS PATIENTS IN BOTSWANA." Thesis, The University of Arizona, 1986. http://hdl.handle.net/10150/275566.
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Tafuma, Taurayi Adriano. "Clinical diagnosis of smear negative pulmonary tuberculosis in HIV-positive patients at Athlone Hospital in Botswana." Thesis, University of Limpopo (Medunsa Campus), 2011. http://hdl.handle.net/10386/546.
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Thesis (MPH)--University of Limpopo (Medunsa Campus), 2011<br>Background and aim: Smear-negative pulmonary tuberculosis (SNPTB) has become an increasingly important clinical and public health problem, especially in areas that are affected by the dual infection of TB and human immunodeficiency virus (HIV) (Mello et al, 2006; WHO, 2006; Harries et al, 1998). There are recommended guidelines for diagnosing SNPTB to reduce misdiagnosis in sub-Saharan Africa, but there is little information on whether these guidelines are followed correctly (Harries et al, 1998). The aim of this study was to investigate the clinical diagnosis of SNPTB in HIV-positive patients at Athlone Hospital in Botswana.
Methods: This was a quantitative, descriptive study which used two sources of data and data collection methods: a 4 year retrospective records review and questionnaires for clinicians. All clinicians responsible for treating HIV-positive patients (n=8) were asked to complete a questionnaire on self-reported (1) compliance with the guidelines (2) use of other methods to diagnose SNPTB and (3) reasons for not complying with the guidelines. All records on SNPTB in HIV-positive patients from 2006 to 2009 (n=281) were reviewed to establish the compliance and use of other methods to exclude other respiratory infections.
Results: The response rate for clinicians was 87.5% (7/8). All clinicians (100% [7/7]) reported (a) always complying with using chest x-rays (CXRs), but (b) only sometimes complying with using 3 sputum results. Most clinicians (a) considered the duration of cough before making a diagnosis of SNPTB (57.1% [4/7]), and (b) placed patients on a trial of broad spectrum antibiotics before starting PTB treatment (85.7% [6/7]). The main reasons for non-compliance were: the inability of patients to submit sputum (100% [7/7]), delays in the laboratory (71.43% [5/7]), and lack of feedback from Botswana National Tuberculosis Program (BNTP) (57.14% [4/7]). Only 2.1% (6/281) of the records showed that other methods were used to rule out other respiratory infections, and overall compliance with the recommended guidelines was only 13.5% (40/281).
Conclusion: The compliance with the recommended guidelines in making a diagnosis of SNPTB was very poor in this study. The unavailability of user-friendly and fast diagnostic methods resulted in many cases being treated for SNPTB with inadequate investigations.
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Kabongo, Diulu. "Effectiveness of home-based directly observed treatment for tuberculosis in Kweneng West subdistrict, Botswana." Thesis, Stellenbosch : Stellenbosch University, 2009. http://hdl.handle.net/10019.1/98215.
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Thesis (MFamMed)--Stellenbosch University, 2015.<br>Introduction:
Tuberculosis and HIV are major public health problems in Botswana. The Botswana National Tuberculosis Control Programme (BNTP) was established in 1975. Short course chemotherapy was introduced in 1986 and the Directly Observed Treatment (DOT) Strategy was adopted in 1993. In the face of growing TB notification rates, a low country average cure rate, human resource constraints in health facilities and sometimes poor accessibility to health facilities by weak patients and those living far away, Botswana decided to offer home-based care using volunteers or family members.
Setting:
Kweneng West Subdistrict, a rural area in Botswana
Aim and objectives:
The aim of this study was to assess the success of home-based DOT in the management of tuberculosis compared to facility-based DOT in Kweneng West Subdistrict, Botswana and to explore the acceptability of home-based DOT among TB patients, TB treatment supervisors and health workers. Objectives:
- To compare treatment outcomes for patients receiving home-based DOT and those receiving facility-based DOT through the following criteria:
- To compare patient contact(s) tracing efforts among home-based providers and facility-based providers
- To establish TB patient’s, TB treatment supervisor’s and health worker’s perceptions about home-based DOT
Methods:
A quantitative, observational study combined with qualitative in-depth interviews. Participants were selected from TB patients who attended treatment from January 2006 till June 2008 at all main clinics of Kweneng West Subdistrict, Botswana. The interview purposively selected health care workers, TB patients and community supervisors to establish their thoughts about HB DOT. A framework approach was used to analyse interviews.
Results:
Treatment outcomes and, particularly, the cure rates were not statistically different between FB DOT, HB DOT and MX DOT. However there was a surprisingly difference in contact tracing, with FB DOT performing better than other DOT types.
Interviews revealed that patients were happy with their choice of DOT types. Among reasons to choose HB DOT was the need to shorten distances for DOT. Among reasons to choose FB DOT were the needs to ensure safety through supervision by nurses as opposed to lay people (community supervisors) and to obtain injections that no community supervisor is allowed to administer. A mix of HB DOT and FB DOT was generally adopted to allow flexibility in the administration of DOT for few patients. Overall cure rate was 78.5% and successful treatment rate was 83%.
Conclusion:
The introduction of HB DOT and the option given to choose this DOT type is supported. Indeed allowing patient’s preference of DOT type may impact positively on patients’ satisfaction and adherence to medication. On the other hand, issues were still raised by all stakeholders to help improve the flexibility and sustainability of HB DOT. Further studies may be needed to understand the better performance of FB DOT in contact tracing.<br>AFRIKAANSE OPSOMMING: Nie beskikbaar.
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Nichols, Carol Anne. "The Influence of Heterogeneous Landscapes on Banded Mongoose (Mungos mungo) Behavior in Northern Botswana: Inferences about Infectious Disease Transmission." Thesis, Virginia Tech, 2018. http://hdl.handle.net/10919/95936.
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Infectious disease transmission is driven by a complex suite of drivers with behavior and landscape dynamics contributing to epidemics across host-pathogen systems. However, our understanding of the interaction between landscape, behavior, and infectious disease remains limited. In the banded mongoose (Mungos mungo), a novel tuberculosis pathogen, Mycobacterium mungi, has emerged in Northern Botswana that is transmitted through olfactory communication behaviors. Using this host-pathogen system, this thesis explores the influence of various land use areas along the human-wildlife interface on animal behavior, and ultimately, pathogen transmission potential. Using behavior data from remote sensing camera traps, a generalized linear mixed model identified vigilance behavior, land use, and their interaction as important factors in predicting olfactory behavior. Cluster and Classification and Regression Tree (CART) analysis of active den sites (n= 308, across 23 troops) identified the important characteristics of dens across land use areas. In human-modified environments, man-made den sites persisted longer than did natural dens which became unsuitable through environmental processes (e.g., collapse). We also document the occurrence of nighttime activity for this species, perceived to be strictly diurnal. These data provide information critical to the development of robust computational models and underscore the importance of both landscape and behavior in accurately predicting and managing infectious disease outbreaks.<br>M. S.
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Boyd, Rosanna M. "Rifampicin-resistant tuberculosis in Botswana: barriers and risk factors influencing patient outcomes, case detection, and linkage to effective care and treatment." Doctoral thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/30540.
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Background: Botswana reports high treatment success for rifampicin-resistant tuberculosis (RR-TB), but many challenges remain. Case detection is lower than expected and varies by year, and mortality rates are high. Research aims included identifying: factors associated with mortality, access to culture and drug susceptibility testing (DST) for patients at risk of RR-TB, access to first- and second-line DST among RR-TB patients, time to RRTB treatment, and patient and provider experiences with RR-TB management. Methods: Retrospective data (multiple cohorts across 2006-2014) were extracted from Botswana national registers and information systems, with additional data collected by standardized, qualitative interviews (2017). Data analyses (Cox proportional hazards regression, survival and hazards curves, logistic regression) were conducted to describe significant associations. A systematic review and meta-analysis was conducted. Thematic analysis was performed for qualitative research. Results: There was low access (42%) to culture testing among patients at risk of RR-TB (previously-treated TB patients); particularly associated with rural residence and having previous successful TB treatment, compared to previous treatment failure. While confirmation of first-line drug resistance was available for 85% of patients initiating RR-TB treatment, access to second-line DST was poor (24%), impacted by limited in-country laboratory capacity. Genotypic DST by Xpert MTB/RIF at peripheral laboratories was associated with faster time to treatment from diagnosis compared to phenotypic DST at the centralized national lab, 5 versus 22 days (median, p<0.001), consistent with systematic review findings of time to RR-TB treatment. Risk factors for mortality during treatment included unconfirmed RR-TB (aHR 2.9), Pre/XDR-TB (aHR 2.5), HIV positivity without ART (aHR 3.6) and receiving treatment at two (of five) specific facilities (aHR 2.6 and 2.3). Qualitative interviews confirmed inconsistent adherence to national policies and identified additional challenges including frequent medication and reagent stock-outs, misperceptions about disease transmission from both providers and patients, and inadequate national level support for the RR-TB program. Conclusion: Several clinical and demographic factors negatively influencing case detection and RR-TB mortality in Botswana were identified. General health system dysfunction and poor political commitment to the RR-TB program also contributed. Recommendations include increased focus on: early diagnosis through universal DST, consistent access to effective drugs, and overall adherence to policies.
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Koskei, Justice Kiplangat. "A strategy for effective tuberculosis contact tracing in Botswana." Thesis, 2016. http://hdl.handle.net/10500/22277.
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Text in English<br>Botswana has witnessed highest TB rates in the southern African countries, ranking the fourth after South Africa, Swaziland and Zimbabwe. In 2012, the TB rate was on average 531/100 000 population. About 2 380 contacts out of a possible 8 110 (amounting to 29.30%) were traced nationally (Botswana 2011:8), indicating a possible gap of 5 730 which was yet to be traced in 2011. The TBCT strategies might be inadequate leading to absence of screening and treating TB contacts and reducing PTB related deaths. The purpose of this study was to describe utilisation of current TBCT and develop a strategy for a more effective TBCT in Botswana.
Data was collected through a quantitative cross-sectional research design. The study further described the association between TBCT strategies and practices and determined the gaps, challenges and needs in the TBCT. Results revealed under-tracing of contacts in the number of registered and enumerated TB contacts. The results further established the risk of mixing TB contacts and the general patients. The differences in the perceptions and knowledge of the cause of TB as well as poor utilisation of the current programmes by the PTB patients denotes the need for aggressive awareness raising and health promotion strategies.
The results were used to develop an alternative strategy, the IC-TBCT, which has a potential to trace all TB contacts. The strategy encourages participation, effective accountability and involvement of the beneficiaries in all efforts aiming at early contact identification and reducing the incidence of PTB.<br>Health Studies<br>D. Litt. et Phil. (Health Studies)
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Bengtsson, Mavis Neo. "Factors contributing to mortality among HIV infected people on Isoniazid Preventive Therapy (IPT) in Botswana." Diss., 2014. http://hdl.handle.net/10500/13272.
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The purpose of the study was to describe factors contributing to mortality among HIVinfected
people on Isoniazid Preventive Therapy (IPT) in Botswana. A quantitative,
explorative, descriptive study was used and 80 records of deceased IPT respondents
were reviewed through the use of a checklist.
The demographic factors, baseline physical examination, hospitalisation and drug
history were taken into consideration. Out of the deceased patients, 75% were female.
The major findings showed that 100% (N=80), the most highly indicated causes of death
were gastroenteritis (18.75%), cryptococcal meningitis (17.5%) andpneumonia
(16.25%). Of the patients (28.75%) who died before completing the six months of IPT.
The causes of death were gastroenteritis (21.7%), symptoms and signs of bacterial
pneumonia (17.4%), cryptococcal meningitis (13%), Pulmonary Tuberculosis (PTB)
(13%), septicaemia (13%), and murder (13%). It has been recommended that there
should be reorganisation of services of care for HIV-infected persons, such as provision
of Cotrimoxazole Prophylaxis Therapy (CPT) and Antiretroviral Therapy (ART) to ensure
holistic approach care. The future study should include HIV-infected children on IPT
using the same or modified objectives. The conclusion drawn was that disintegrated
interventions of IPT, CPT and ART and lack of holistic care for PLHIV lead to
opportunistic infections that caused mortality on patients on IPT.<br>Department of Health Studies<br>M.A. (Public Health)
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Rankosha, Omphemetse. "Factors affecting the uptake of community TB care in Lobatse district of Botswana as experienced by patients." Diss., 2014. http://hdl.handle.net/10500/18695.
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The study aimed to assess factors affecting the uptake of community-based
Tuberculosis care (CTBC) as experienced by patients in Lobatse in order to make
recommendations to enhance the uptake of CBTC in this area.
A cross-sectional study was conducted, using structured interviews amongst 101 TB
patients in Lobatse who registered for directly observed treatment (DOT) for TB in the
GOB’s health facilities from January 2011 to August 2013. The SPSS (version 21) was
used to analyse the data. Univariate logistic regression models were used. Participation
in CTBC was an outcome.
The main predictors for participation in CBTC included, knowledge and attitudes
towards CTBC (p=0.0003), perceived barriers and enablers towards this programme
(p=0.0279), and patient satisfaction with this programme (p=0.0315).
The research findings pertain to TB services in Lobatse, because the study was
conducted in government health facilities implementing the Botswana National
Tuberculosis Programme (BNTP) CTBC guidelines only in Lobatse<br>Health Studies<br>M.A. (Public Health)
Books on the topic "Tuberculosis – Botswana"
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Tuberculosis and traditional medicine in Botswana: How Tb-patients perceive modern and traditional causality and Tb-treatment : interviews with Tb-patients in rural Botswana. Express Edition, 1986.
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Southern Africa TB/HIV Co-infection Conference (1994 Gaborone, Botswana). Southern Africa TB/HIV Co-infection Conference: Regional collaboration in T.B. control : Gaborone Sun, 7-11 November, 1994, Gaborone, Botswana. The Republic, 1994.
Find full textBook chapters on the topic "Tuberculosis – Botswana"
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Dye, Christopher. "Strains and Drug Resistance." In The Population Biology of Tuberculosis. Princeton University Press, 2015. http://dx.doi.org/10.23943/princeton/9780691154626.003.0005.
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This chapter examines the geographical distribution of resistant forms of Mycobacterium tuberculosis and their time trends. Apart from drug resistance, there are plenty of other main questions about M. tuberculosis population genetics. To combat epidemics of drug-resistant TB, it is vital to understand why some resistant strains have greater reproductive fitness than drug-susceptible strains. The chapter first provides an overview of genetic variation in M. tuberculosis before discussing resistance (new and acquired) to first-and second-line drugs. It then considers the link between drug resistance and HIV coinfection, global distribution of drug-resistant TB, relative reproductive fitness, and absolute reproductive fitness. It shows that drug resistance is preventable and reversible, but this must be corroborated and expanded with longer series of data from a wider range of countries, countries with high rates of HIV infection (for example, Botswana and South Africa), and those reporting cases of extensively drug-resistant TB (XDR-TB).