K Charambira1, S Ade2, A D Harries3, R T Ncube1, C Zishiri1, C Sandy4, H Mutunzi4, K Takarinda5, P Owiti6, P Mafaune4, P Chonzi7. 1. International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe. 2. The Union, Paris, France ; National Tuberculosis Programme, Cotonou, Benin. 3. The Union, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK. 4. Ministry of Health and Child Care, Harare, Zimbabwe. 5. The Union, Paris, France ; Ministry of Health and Child Care, Harare, Zimbabwe. 6. The Union, Paris, France. 7. Harare City Health Department, Harare, Zimbabwe.
Abstract
SETTING: In Zimbabwe, there are concerns about the management of tuberculosis (TB) patients with rifampicin (RMP) resistance diagnosed using Xpert(®) MTB/RIF. OBJECTIVE: To assess linkages between diagnosis and treatment for these patients in Harare and Manicaland provinces in 2014. DESIGN: A retrospective cohort study. RESULTS: Of 20 329 Xpert assays conducted, 90% were successful, 11% detected Mycobacterium tuberculosis and 4.5% showed RMP resistance. Of 77 patients with RMP-resistant TB diagnosed by Xpert, 70% had samples sent to the reference laboratory for culture and drug susceptibility testing (CDST); 53% of the samples arrived. In 21% the samples showed M. tuberculosis growth, and in 17% the DST results were recorded, all of which confirmed RMP resistance. Of the 77 patients, 34 (44%) never started treatment for multidrug-resistant (MDR) TB, with documented reasons being death, loss to follow-up and incorrect treatment. Of the 43 patients who started MDR-TB treatment, 12 (71%) in Harare and 17 (65%) in Manicaland started within 2 weeks of diagnosis. CONCLUSION: Xpert has been rolled out successfully in two Zimbabwe provinces. However, the process of confirming CDST for Xpert-diagnosed RMP-resistant TB works poorly, and many patients are either delayed or never initiate MDR-TB treatment. These shortfalls must be addressed at the programmatic level.
SETTING: In Zimbabwe, there are concerns about the management of tuberculosis (TB) patients with rifampicin (RMP) resistance diagnosed using Xpert(®) MTB/RIF. OBJECTIVE: To assess linkages between diagnosis and treatment for these patients in Harare and Manicaland provinces in 2014. DESIGN: A retrospective cohort study. RESULTS: Of 20 329 Xpert assays conducted, 90% were successful, 11% detected Mycobacterium tuberculosis and 4.5% showed RMP resistance. Of 77 patients with RMP-resistant TB diagnosed by Xpert, 70% had samples sent to the reference laboratory for culture and drug susceptibility testing (CDST); 53% of the samples arrived. In 21% the samples showed M. tuberculosis growth, and in 17% the DST results were recorded, all of which confirmed RMP resistance. Of the 77 patients, 34 (44%) never started treatment for multidrug-resistant (MDR) TB, with documented reasons being death, loss to follow-up and incorrect treatment. Of the 43 patients who started MDR-TB treatment, 12 (71%) in Harare and 17 (65%) in Manicaland started within 2 weeks of diagnosis. CONCLUSION: Xpert has been rolled out successfully in two Zimbabwe provinces. However, the process of confirming CDST for Xpert-diagnosed RMP-resistant TB works poorly, and many patients are either delayed or never initiate MDR-TB treatment. These shortfalls must be addressed at the programmatic level.
Entities:
Keywords:
MDR-TB; RMP resistance; SORT IT; Xpert MTB/RIF; culture and drug susceptibility testing; tuberculosis
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