E De Vos1, L Scott2, Y Voss De Lima3, R M Warren4, W Stevens5, C Hayes6, P da Silva7, A Van Rie1. 1. Faculty of Medicine and Health Sciences, University of Antwerp, Belgium. 2. Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa. 3. Instituto Nacional De Saúde, Maputo, Mozambique. 4. South African Medical Research Council Centre for Tuberculosis Research/Stellenbosch University, Stellenbosch. 5. Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa, Molecular Medicine & Haematology, National Health Laboratory Service, Johannesburg. 6. National Health Laboratory Services, Port Elizabeth, South Africa. 7. Molecular Medicine & Haematology, National Health Laboratory Service, Johannesburg.
Abstract
BACKGROUND: Xpert® MTB/RIF was expected to revolutionise the management of rifampicin-resistant TB (RR-TB) by enabling rapid and decentralised diagnosis of rifampicin (RIF) resistance. METHODS: We performed a care cascade analysis for a cohort of RR-TB patients managed under programmatic conditions. Cumulative incidences of time to completion of the RR-TB care cascade steps were estimated, reasons for delay or attrition from the cascade investigated and WHO programme indicators for monitoring of RR-TB programmes calculated. RESULTS: Of 502 patients diagnosed with RR-TB using Xpert, 64% initiated multidrug-resistant TB (MDR-TB) treatment immediately, 20% after some first-line treatment, 16% never initiated MDR-TB treatment, mainly because of death (44%) or loss to follow-up (26%) soon after diagnosis. A supplementary sputum sample was collected within 14 days of treatment in 58.8% of cases. Only 63% of RR-TB cases were assessed for isoniazid resistance, and only 65% of MDR-TB cases were evaluated for pre-XDR-TB (extensively drug-resistant TB). Treatment was individualised in 57% of pre-XDR and 68% of XDR-TB patients. Only 8% completed the entire RR-TB care cascade as intended. CONCLUSION: Fidelity to the RR-TB algorithm was poor, with substantial losses at each step of the cascade, highlighting the fact that implementation of novel technologies needs to be accompanied by health system strengthening to maximise impact.
BACKGROUND: Xpert® MTB/RIF was expected to revolutionise the management of rifampicin-resistant TB (RR-TB) by enabling rapid and decentralised diagnosis of rifampicin (RIF) resistance. METHODS: We performed a care cascade analysis for a cohort of RR-TB patients managed under programmatic conditions. Cumulative incidences of time to completion of the RR-TB care cascade steps were estimated, reasons for delay or attrition from the cascade investigated and WHO programme indicators for monitoring of RR-TB programmes calculated. RESULTS: Of 502 patients diagnosed with RR-TB using Xpert, 64% initiated multidrug-resistant TB (MDR-TB) treatment immediately, 20% after some first-line treatment, 16% never initiated MDR-TB treatment, mainly because of death (44%) or loss to follow-up (26%) soon after diagnosis. A supplementary sputum sample was collected within 14 days of treatment in 58.8% of cases. Only 63% of RR-TB cases were assessed for isoniazid resistance, and only 65% of MDR-TB cases were evaluated for pre-XDR-TB (extensively drug-resistant TB). Treatment was individualised in 57% of pre-XDR and 68% of XDR-TB patients. Only 8% completed the entire RR-TB care cascade as intended. CONCLUSION: Fidelity to the RR-TB algorithm was poor, with substantial losses at each step of the cascade, highlighting the fact that implementation of novel technologies needs to be accompanied by health system strengthening to maximise impact.
Authors: Annelies Van Rie; John Z Metcalfe; Michael G Whitfield; David M Engelthaler; Christopher Allender; Megan Folkerts; Tim H Heupink; Jason Limberis; Robin M Warren Journal: J Clin Microbiol Date: 2021-11-10 Impact factor: 5.948
Authors: Lennert Verboven; Toon Calders; Steven Callens; John Black; Gary Maartens; Kelly E Dooley; Samantha Potgieter; Robin M Warren; Kris Laukens; Annelies Van Rie Journal: BMC Med Inform Decis Mak Date: 2022-03-02 Impact factor: 2.796
Authors: Annelies Van Rie; Elise De Vos; Emilyn Costa; Lennert Verboven; Felex Ndebele; Tim H Heupink; Steven Abrams; Boitumelo Fanampe; Anneke Van der Spoel Van Dyk; Salome Charalambous; Gavin Churchyard; Rob Warren Journal: Trials Date: 2022-10-08 Impact factor: 2.728