- Title
- The effect of the Xpert MTB/RIF test on the time to MDR-TB treatment initiation in a rural setting: a cohort study in South Africa’s Eastern Cape Province
- Creator
- Iruedo, Joshua
- Creator
- O’Mahony , Don
- Creator
- Mabunda, Sikhumbuzo A
- Creator
- Wright, Graham
- Creator
- Cawe , Busisiwe
- Description
- Background: There are significant delays in initiation of multidrug-resistant tuberculosis (MDR –TB) treatment. The Xpert MTB/RIF test has been shown to reduce the time to diagnosis and treatment of MDR-TB predominantly in urban centres. This study describes the time to treatment of MDR-TB and the effect of Xpert MTB/RIF on time to treatment in a deprived rural area in South Africa. Methods: This was a retrospective cohort study analysing the medical records of patients diagnosed with MDR-TB in King Sabata Dalindyebo Sub-District between 2009 and 2014. Numerical data were reported using the Kruskal-Wallis and Wilcoxon sum rank tests and categorical data compared using the two-sample test of proportions. Results: Of the 342 patients with MDR-TB identified, 285 were eligible for analysis, of whom 145 (61.4%) were HIV positive. The median time from sputum collection to MDR-TB diagnosis was 27 days (IQR: 2–45) and differed significantly between diagnostic modalities: Xpert MTB/RIF, 1 day (IQR: 1–4; n = 114: p less 0.0001); Line Probe Assay 12 days (IQR: 8–21; n = 28; p less 0.0001); and culture/phenotypic drug sensitivity testing 45 days (IQR: 39–59; n = 143: p less 0.0001). The time from diagnosis to treatment initiation was 14 days (IQR: 8–27) and did not differ significantly between diagnostic modality. The median time from sputum collection to treatment initiation was 49 days (IQR: 20–69) but differed significantly between diagnostic modalities: Xpert MTB/RIF, 18 days (IQR: 11–27; n = 114; p less 0.0001); Line Probe Assay 29 days (IQR: 14.5–53; n = 28; p les 0.0001); and culture/phenotypic drug sensitivity, 64 days (IQR: 50–103; n = 143: P less 0.0001). Age, sex and HIV status did not influence the time intervals. Conclusions: Xpert MTB/RIF significantly reduced the time to MDR-TB treatment in a deprived rural setting as a result of a reduced time to diagnosis. However, the national target of five days was not achieved. Further research is needed to explore and address programmatic and patient-related challenges contributing to delayed treatment initiation. Keywords: Xpert MTB/RIF, MDR-TB, Rural, Time-to-treatment, Cohort study
- Date
- 2017
- Subject
- South Africa Multidrug-resistant tuberculosis Computer File
- Type
- text, article
- Identifier
- http://hdl.handle.net/11260/6098
- Identifier
- vital:45115
- Identifier
- https://DOI10.1186/s12879-017-2200-8
- Format
- 9 pages, pdf
- Publisher
- Biomed Central
- Language
- English
- Relation
- BMC Infectious Diseases, Iruedo et al. BMC Infectious Diseases (2017) 17:91 DOI 10.1186/s12879-017-2200-8., BMC Infectious Diseases volume 17 number 91 1 9 2017
- Rights
- © Iruedo et al. 2017, This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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