S Tahseen1, M R Siddiqui2, F M Khanzada1, M M Bhutto3, A Q Baloch4, W Van Gemert5, J Creswell5. 1. National TB Reference Laboratory, National TB Control Programme, Islamabad. 2. Institute of Chest Diseases Kotri, Jamshoro. 3. Provincial Reference Laboratory, Provincial TB Control Programme, Karachi, Sindh Health Care Commission, Karachi. 4. National TB Control Program, Islamabad, Pakistan. 5. Stop TB Partnership, Geneva, Switzerland.
Abstract
SETTING: A large specialised chest hospital in Pakistan. OBJECTIVE: To study outcomes of comprehensive Xpert® MTB/RIF and universal rifampicin testing. DESIGN: A hospital-based, 3-year retrospective record review of registered TB patients. RESULTS: During the study, 11 744 TB patients were registered when the number of annual notifications remained stagnant. Xpert use increased dramatically in adults with pulmonary TB (PTB) from less than 1% tested with Xpert alone in 2016, to 81.6% by 2018. Significant increases were seen in bacteriologically confirmed PTB in adults from 64% to 77.3% (P < 0.001). No remarkable changes were seen in testing and confirmation of PTB in children or extrapulmonary TB. Significantly lower (P < 0.001) rifampicin resistance (RR) was observed among those with smear-negative compared to those with smear-positive results among new (1.0% vs. 5.1%) and previously treated PTB cases (2.0% vs. 14.4%). Most importantly, a significant decline in RR was observed among previously treated individuals, from 15.4% (95%CI 12.2-19.0) to 8.6% (95%CI 6.6-11.0) during the study. A decrease in RR was also documented in newly diagnosed PTB patients, but this was not statistically significant. CONCLUSION: Universal rifampicin testing is feasible in adult PTB patients; a decline in RR was seen among previously treated individuals with PTB.
SETTING: A large specialised chest hospital in Pakistan. OBJECTIVE: To study outcomes of comprehensive Xpert® MTB/RIF and universal rifampicin testing. DESIGN: A hospital-based, 3-year retrospective record review of registered TBpatients. RESULTS: During the study, 11 744 TBpatients were registered when the number of annual notifications remained stagnant. Xpert use increased dramatically in adults with pulmonary TB (PTB) from less than 1% tested with Xpert alone in 2016, to 81.6% by 2018. Significant increases were seen in bacteriologically confirmed PTB in adults from 64% to 77.3% (P < 0.001). No remarkable changes were seen in testing and confirmation of PTB in children or extrapulmonary TB. Significantly lower (P < 0.001) rifampicin resistance (RR) was observed among those with smear-negative compared to those with smear-positive results among new (1.0% vs. 5.1%) and previously treated PTB cases (2.0% vs. 14.4%). Most importantly, a significant decline in RR was observed among previously treated individuals, from 15.4% (95%CI 12.2-19.0) to 8.6% (95%CI 6.6-11.0) during the study. A decrease in RR was also documented in newly diagnosed PTB patients, but this was not statistically significant. CONCLUSION: Universal rifampicin testing is feasible in adult PTB patients; a decline in RR was seen among previously treated individuals with PTB.