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The Impact of Expanded Testing for Multidrug Resistant Tuberculosis Using Geontype MTBDRplus in South Africa: An Observational Cohort Study

INTRODUCTION: Globally, multidrug resistant tuberculosis (MDR-TB) remains underdiagnosed. The Genotype MTBDRplus®, a rapid drug susceptibility testing (DST) assay used to detect resistance to isoniazid and rifampicin in the diagnosis of MDR-TB, has good diagnostic accuracy, but its impact on patient...

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Autores principales: Hanrahan, Colleen F., Dorman, Susan E., Erasmus, Linda, Koornhof, Hendrik, Coetzee, Gerrit, Golub, Jonathan E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3511489/
https://www.ncbi.nlm.nih.gov/pubmed/23226229
http://dx.doi.org/10.1371/journal.pone.0049898
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author Hanrahan, Colleen F.
Dorman, Susan E.
Erasmus, Linda
Koornhof, Hendrik
Coetzee, Gerrit
Golub, Jonathan E.
author_facet Hanrahan, Colleen F.
Dorman, Susan E.
Erasmus, Linda
Koornhof, Hendrik
Coetzee, Gerrit
Golub, Jonathan E.
author_sort Hanrahan, Colleen F.
collection PubMed
description INTRODUCTION: Globally, multidrug resistant tuberculosis (MDR-TB) remains underdiagnosed. The Genotype MTBDRplus®, a rapid drug susceptibility testing (DST) assay used to detect resistance to isoniazid and rifampicin in the diagnosis of MDR-TB, has good diagnostic accuracy, but its impact on patient outcomes in routine practice is unproven. We assessed the clinical impact of routine DST using MTBDRplus in a single health district in South Africa. METHODS: Data were collected on all adult pulmonary TB patients registered at 25 public health clinics in the periods before and after introduction of an expanded DST algorithm using MTBDRplus version 1.0. RESULTS: We collected data on 1176 TB patients before implementation and 1177 patients afterwards. In the before period, measured MDR-TB prevalence among new cases was 0.7% (95% CI1.4–3.1%), and among retreatment cases 6.2% (95% CI:3.5–8.8%), versus 3.7% (95% CI:2.4–5.0, p<0.01) and 6.6% (95% CI:3.8–9.4%, p = 0.83) respectively after MTBDRplus introduction. The median times from sputum collection to MDR treatment in the before and after periods were 78 days (IQR:52–93) and 62 days (IQR:32–86, p = 0.05), respectively. Among MDR-TB cases, 27% (95%CI:10–44) in the before period converted sputum cultures to negative by 8 months following treatment initiation, while 52% (95%CI:38–66) converted in the intervention period (p = 0.04). CONCLUSIONS: The expanded use of MTBDRplus DST resulted in a substantial increase in the proportion of new cases identified as MDR-TB; though time to MDR treatment was reduced, it was still over two months. Culture conversion for MDR-TB patients improved after introduction of MTBDRplus. This work illustrates the mixture of successes and challenges resulting from increased access to rapid DST in a setting with a high TB burden.
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spelling pubmed-35114892012-12-05 The Impact of Expanded Testing for Multidrug Resistant Tuberculosis Using Geontype MTBDRplus in South Africa: An Observational Cohort Study Hanrahan, Colleen F. Dorman, Susan E. Erasmus, Linda Koornhof, Hendrik Coetzee, Gerrit Golub, Jonathan E. PLoS One Research Article INTRODUCTION: Globally, multidrug resistant tuberculosis (MDR-TB) remains underdiagnosed. The Genotype MTBDRplus®, a rapid drug susceptibility testing (DST) assay used to detect resistance to isoniazid and rifampicin in the diagnosis of MDR-TB, has good diagnostic accuracy, but its impact on patient outcomes in routine practice is unproven. We assessed the clinical impact of routine DST using MTBDRplus in a single health district in South Africa. METHODS: Data were collected on all adult pulmonary TB patients registered at 25 public health clinics in the periods before and after introduction of an expanded DST algorithm using MTBDRplus version 1.0. RESULTS: We collected data on 1176 TB patients before implementation and 1177 patients afterwards. In the before period, measured MDR-TB prevalence among new cases was 0.7% (95% CI1.4–3.1%), and among retreatment cases 6.2% (95% CI:3.5–8.8%), versus 3.7% (95% CI:2.4–5.0, p<0.01) and 6.6% (95% CI:3.8–9.4%, p = 0.83) respectively after MTBDRplus introduction. The median times from sputum collection to MDR treatment in the before and after periods were 78 days (IQR:52–93) and 62 days (IQR:32–86, p = 0.05), respectively. Among MDR-TB cases, 27% (95%CI:10–44) in the before period converted sputum cultures to negative by 8 months following treatment initiation, while 52% (95%CI:38–66) converted in the intervention period (p = 0.04). CONCLUSIONS: The expanded use of MTBDRplus DST resulted in a substantial increase in the proportion of new cases identified as MDR-TB; though time to MDR treatment was reduced, it was still over two months. Culture conversion for MDR-TB patients improved after introduction of MTBDRplus. This work illustrates the mixture of successes and challenges resulting from increased access to rapid DST in a setting with a high TB burden. Public Library of Science 2012-11-30 /pmc/articles/PMC3511489/ /pubmed/23226229 http://dx.doi.org/10.1371/journal.pone.0049898 Text en © 2012 Hanrahan et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Hanrahan, Colleen F.
Dorman, Susan E.
Erasmus, Linda
Koornhof, Hendrik
Coetzee, Gerrit
Golub, Jonathan E.
The Impact of Expanded Testing for Multidrug Resistant Tuberculosis Using Geontype MTBDRplus in South Africa: An Observational Cohort Study
title The Impact of Expanded Testing for Multidrug Resistant Tuberculosis Using Geontype MTBDRplus in South Africa: An Observational Cohort Study
title_full The Impact of Expanded Testing for Multidrug Resistant Tuberculosis Using Geontype MTBDRplus in South Africa: An Observational Cohort Study
title_fullStr The Impact of Expanded Testing for Multidrug Resistant Tuberculosis Using Geontype MTBDRplus in South Africa: An Observational Cohort Study
title_full_unstemmed The Impact of Expanded Testing for Multidrug Resistant Tuberculosis Using Geontype MTBDRplus in South Africa: An Observational Cohort Study
title_short The Impact of Expanded Testing for Multidrug Resistant Tuberculosis Using Geontype MTBDRplus in South Africa: An Observational Cohort Study
title_sort impact of expanded testing for multidrug resistant tuberculosis using geontype mtbdrplus in south africa: an observational cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3511489/
https://www.ncbi.nlm.nih.gov/pubmed/23226229
http://dx.doi.org/10.1371/journal.pone.0049898
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