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Treatment initiation among persons diagnosed with drug resistant tuberculosis in Johannesburg, South Africa

BACKGROUND: In South Africa, roughly half of the drug-resistant TB cases diagnosed are reported to have been started on treatment. We determined the proportion of persons diagnosed with rifampicin resistant (RR-) TB who initiated treatment in Johannesburg after the introduction of decentralized RR-T...

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Autores principales: Evans, Denise, Schnippel, Kathryn, Govathson, Caroline, Sineke, Tembeka, Black, Andrew, Long, Lawrence, Berhanu, Rebecca, Rosen, Sydney
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5529007/
https://www.ncbi.nlm.nih.gov/pubmed/28746344
http://dx.doi.org/10.1371/journal.pone.0181238
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author Evans, Denise
Schnippel, Kathryn
Govathson, Caroline
Sineke, Tembeka
Black, Andrew
Long, Lawrence
Berhanu, Rebecca
Rosen, Sydney
author_facet Evans, Denise
Schnippel, Kathryn
Govathson, Caroline
Sineke, Tembeka
Black, Andrew
Long, Lawrence
Berhanu, Rebecca
Rosen, Sydney
author_sort Evans, Denise
collection PubMed
description BACKGROUND: In South Africa, roughly half of the drug-resistant TB cases diagnosed are reported to have been started on treatment. We determined the proportion of persons diagnosed with rifampicin resistant (RR-) TB who initiated treatment in Johannesburg after the introduction of decentralized RR-TB care in 2011. METHODS: We retrospectively matched adult patients diagnosed with laboratory-confirmed RR-TB in Johannesburg from 07/2011-06/2012 with records of patients initiating RR-TB treatment at one of the city’s four public sector treatment sites (one centralized, three decentralized). Patients were followed from date of diagnosis until the earliest of RR-TB treatment initiation, death, or 6 months’ follow-up. We report diagnostic methods and outcomes, proportions initiating treatment, and median time from diagnosis to treatment initiation. RESULTS: 594 patients were enrolled (median age 34 (IQR 29–42), 287 (48.3%) female). Diagnosis was by GenoType MTBDRplus (Hain-Life-Science) line probe assay (LPA) (281, 47.3%), Xpert MTB/RIF (Cepheid) (258, 43.4%), or phenotypic drug susceptibility testing (DST) (30, 5.1%) with 25 (4.2%) missing a diagnosis method. 320 patients (53.8%) had multi-drug resistant TB, 158 (26.6%) rifampicin resistant TB by Xpert MTB/RIF, 102 (17.2%) rifampicin mono-resistance, and 14 (2.4%) extensively drug-resistant TB. 256/594 (43.0%) patients initiated treatment, representing 70.7% of those who were referred for treatment (362/594). 338/594 patients (57.0%) did not initiate treatment, including 104 (17.5%) who died before treatment was started. The median time from sputum collection to treatment initiation was 33 days (IQR 12–52). CONCLUSION: Despite decentralized RR-TB treatment, fewer than half the patients diagnosed in Johannesburg initiated appropriate treatment. Offering treatment at decentralized sites alone is not sufficient; improvements in linking patients diagnosed with RR-TB to effective treatment is essential.
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spelling pubmed-55290072017-08-07 Treatment initiation among persons diagnosed with drug resistant tuberculosis in Johannesburg, South Africa Evans, Denise Schnippel, Kathryn Govathson, Caroline Sineke, Tembeka Black, Andrew Long, Lawrence Berhanu, Rebecca Rosen, Sydney PLoS One Research Article BACKGROUND: In South Africa, roughly half of the drug-resistant TB cases diagnosed are reported to have been started on treatment. We determined the proportion of persons diagnosed with rifampicin resistant (RR-) TB who initiated treatment in Johannesburg after the introduction of decentralized RR-TB care in 2011. METHODS: We retrospectively matched adult patients diagnosed with laboratory-confirmed RR-TB in Johannesburg from 07/2011-06/2012 with records of patients initiating RR-TB treatment at one of the city’s four public sector treatment sites (one centralized, three decentralized). Patients were followed from date of diagnosis until the earliest of RR-TB treatment initiation, death, or 6 months’ follow-up. We report diagnostic methods and outcomes, proportions initiating treatment, and median time from diagnosis to treatment initiation. RESULTS: 594 patients were enrolled (median age 34 (IQR 29–42), 287 (48.3%) female). Diagnosis was by GenoType MTBDRplus (Hain-Life-Science) line probe assay (LPA) (281, 47.3%), Xpert MTB/RIF (Cepheid) (258, 43.4%), or phenotypic drug susceptibility testing (DST) (30, 5.1%) with 25 (4.2%) missing a diagnosis method. 320 patients (53.8%) had multi-drug resistant TB, 158 (26.6%) rifampicin resistant TB by Xpert MTB/RIF, 102 (17.2%) rifampicin mono-resistance, and 14 (2.4%) extensively drug-resistant TB. 256/594 (43.0%) patients initiated treatment, representing 70.7% of those who were referred for treatment (362/594). 338/594 patients (57.0%) did not initiate treatment, including 104 (17.5%) who died before treatment was started. The median time from sputum collection to treatment initiation was 33 days (IQR 12–52). CONCLUSION: Despite decentralized RR-TB treatment, fewer than half the patients diagnosed in Johannesburg initiated appropriate treatment. Offering treatment at decentralized sites alone is not sufficient; improvements in linking patients diagnosed with RR-TB to effective treatment is essential. Public Library of Science 2017-07-26 /pmc/articles/PMC5529007/ /pubmed/28746344 http://dx.doi.org/10.1371/journal.pone.0181238 Text en © 2017 Evans 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 (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Evans, Denise
Schnippel, Kathryn
Govathson, Caroline
Sineke, Tembeka
Black, Andrew
Long, Lawrence
Berhanu, Rebecca
Rosen, Sydney
Treatment initiation among persons diagnosed with drug resistant tuberculosis in Johannesburg, South Africa
title Treatment initiation among persons diagnosed with drug resistant tuberculosis in Johannesburg, South Africa
title_full Treatment initiation among persons diagnosed with drug resistant tuberculosis in Johannesburg, South Africa
title_fullStr Treatment initiation among persons diagnosed with drug resistant tuberculosis in Johannesburg, South Africa
title_full_unstemmed Treatment initiation among persons diagnosed with drug resistant tuberculosis in Johannesburg, South Africa
title_short Treatment initiation among persons diagnosed with drug resistant tuberculosis in Johannesburg, South Africa
title_sort treatment initiation among persons diagnosed with drug resistant tuberculosis in johannesburg, south africa
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5529007/
https://www.ncbi.nlm.nih.gov/pubmed/28746344
http://dx.doi.org/10.1371/journal.pone.0181238
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