Dina Nair1, Pooranaganga D Navneethapandian2, Jaya Prasad Tripathy3, Anthony D Harries4,5, Joel S Klinton2, Basilea Watson2, Gomathi N Sivaramakrishnan2, Devarajulu S Reddy2, Lakshmi Murali6, Mohan Natrajan2, Soumya Swaminathan7. 1. National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India dinanair73@yahoo.co.in. 2. National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India. 3. International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India. 4. International Union Against Tuberculosis and Lung Disease, Paris, France. 5. London School of Hygiene and Tropical Medicine, Keppel Street, London, UK. 6. State TB Cell, Directorate of Health Services, Tamil Nadu, India. 7. Indian Council of Medical Research, New Delhi, India.
Abstract
BACKGROUND: India is replacing culture and drug sensitivity testing (CDST) with rapid molecular tests for diagnosing MDR-TB. We assessed the impact of rapid tests on time to initiation of treatment and outcomes in patients with MDR-TB compared with CDST. METHODS: A retrospective cohort study involving MDR-TB patients from six districts in Tamil Nadu state, who underwent CDST (2010-2011) and rapid tests (2012-2013). RESULTS: There were 135 patients in the CDST group and 389 in the rapid diagnostic test group. Median time from sputum receipt at the laboratory to initiation of MDR-TB treatment was 130 days (IQR 75-213) in the CDST group and 22 days (IQR 14-38) in the rapid diagnostic test group (p<0.001). Overall treatment success was 30% with CDST and 41% with rapid tests (p<0.05), but there was high loss to follow-up >30% in both groups and missing data were higher in CDST (13%) compared with rapid tests (3%). There were significantly higher risks of unfavourable treatment outcomes in males (aRR 1.3, 95% CI 1.1-1.5) and those with treatment initiation delays >30 days (aRR 1.3, 95% CI 1.0-1.6). CONCLUSION: Rapid molecular diagnostic tests shortened the time to initiate treatment which was associated with reduced unfavourable outcomes in MDR-TB patients. This supports the policy to scale up these tests in India.
BACKGROUND: India is replacing culture and drug sensitivity testing (CDST) with rapid molecular tests for diagnosing MDR-TB. We assessed the impact of rapid tests on time to initiation of treatment and outcomes in patients with MDR-TB compared with CDST. METHODS: A retrospective cohort study involving MDR-TB patients from six districts in Tamil Nadu state, who underwent CDST (2010-2011) and rapid tests (2012-2013). RESULTS: There were 135 patients in the CDST group and 389 in the rapid diagnostic test group. Median time from sputum receipt at the laboratory to initiation of MDR-TB treatment was 130 days (IQR 75-213) in the CDST group and 22 days (IQR 14-38) in the rapid diagnostic test group (p<0.001). Overall treatment success was 30% with CDST and 41% with rapid tests (p<0.05), but there was high loss to follow-up >30% in both groups and missing data were higher in CDST (13%) compared with rapid tests (3%). There were significantly higher risks of unfavourable treatment outcomes in males (aRR 1.3, 95% CI 1.1-1.5) and those with treatment initiation delays >30 days (aRR 1.3, 95% CI 1.0-1.6). CONCLUSION: Rapid molecular diagnostic tests shortened the time to initiate treatment which was associated with reduced unfavourable outcomes in MDR-TB patients. This supports the policy to scale up these tests in India.
Authors: Julia V Ershova; Grigory V Volchenkov; Tatiana R Somova; Tatiana A Kuznetsova; Natalia V Kaunetis; Dorothy Kaminski; Olga V Demikhova; Larisa N Chernousova; Irina A Vasilyeva; Eleanor M Kerr; J Peter Cegielski; Ekaterina V Kurbatova Journal: BMC Infect Dis Date: 2020-07-25 Impact factor: 3.090