Decreased Time to Treatment Initiation for Multidrug-Resistant Tuberculosis Patients after Use of Xpert MTB/RIF Test, Latvia

White, Peter J; Riekstiņa, Vija; Cīrule, Andra; Šķenders, Ģirts; Leimane, Vaira; Kukša, Līga; Dravniece, Gunta; Brown, James; Jackson, Charlotte

doi:10.3201/eid2203.151227

Cited by 20 publications

(15 citation statements)

References 17 publications

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“…Compared with other studies that investigated time to treatment of MDR-TB patients, time to treatment in our cohort was longer than that of other studies [4,11,22–24], which was mainly due to the difference in the rate of performance of rapid molecular DSTs. The utility of rapid molecular DSTs such as LPAs for INH and RIF and the Xpert MTB/RIF assay is well known.…”

Section: Discussioncontrasting

confidence: 69%

Time to appropriate treatment in patients with multidrug-resistant tuberculosis in South Korea: Are we still in 2010?

Park

Lee

et al. 2019

PLoS ONE

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Background This study investigated the time to appropriate treatment and factors affecting late treatment initiation in patients with multidrug-resistant tuberculosis (MDR-TB) in South Korea. Methods Data from patients with culture-confirmed pulmonary MDR-TB who received treatment at Pusan National University Hospital (PNUH) between January 2010 and July 2018 were reviewed retrospectively. Patients were divided into two groups according to the first institution they visited [patients who were transferred to PNUH after diagnosis of MDR-TB (Group A) and patients who were initially diagnosed with TB at PNUH (Group B)]. Results A total of 100 patients were included (53 in Group A and 47 in Group B). The percentage of patients in whom line probe assays (LPAs) for isoniazid and rifampin or Xpert MTB/RIF assays were performed was higher in Group B than in Group A [20.8 vs . 57.4% ( P < 0.001) and 17.0 vs . 46.8% ( P = 0.001), respectively]. The median time from the first visit to appropriate treatment initiation was longer in Group A (102.0 vs . 77.0 days, P = 0.002). However, a subgroup analysis of patients with pre-extensively or extensively drug-resistant TB (pre-XDR- or XDR-TB) revealed that the time to appropriate treatment did not differ between Groups A and B. Although the time to appropriate treatment decreased during the study period in both Groups A and B, this trend was not evident in patients with pre-XDR- or XDR-TB in Group B. Based on multivariate analyses, performance of LPAs for isoniazid and rifampin, performance of Xpert MTB/RIF assays, and the presence of uncomplicated MDR-TB were protective against delays in appropriate treatment initiation. Conclusions The time to appropriate treatment in patients with MDR-TB in South Korea was not acceptable, particularly for patients diagnosed outside of PNUH and for patients with pre-XDR- or XDR-TB. The use of rapid molecular drug susceptibility tests in various healthcare settings and introduction of second-line LPAs are required.

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Section: Discussioncontrasting

confidence: 69%

Time to appropriate treatment in patients with multidrug-resistant tuberculosis in South Korea: Are we still in 2010?

Park

Lee

et al. 2019

PLoS ONE

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“…Treatment delay has been one of the major factors imposing a challenge to TB prevention and control [12]. Delayed treatment initiation leads to increased morbidity, mortality, and the progression of the disease to severe and complicated forms [13–15]. Besides, patients with cavitary lesions and high bacilli loads are associated with an increased primary form of drug resistant TB and rapid person-person transmissions [16].…”

Section: Introductionmentioning

confidence: 99%

“…Treatment delays which were studied in both high and low income countries significantly varied from 9 days in China [8] to 19 days in India [17], and from 10 days in South Africa [18] to 18 days in Zimbabwe [19]. Patient related factors such as health seeking behavior and distance from health facilities from residences [18] as well as the history of anti-TB treatment [8, 15] and diagnostic modalities [6, 20, 21] were significantly associated with delayed treatment initiations. In addition, health facility factors were contributing to treatment delays due to inadequate treatment initiating centers (TICs) with limited beds [22].…”

Section: Introductionmentioning

confidence: 99%

Treatment delay and associated factors among adults with drug resistant tuberculosis at treatment initiating centers in the Amhara regional state, Ethiopia

et al. 2019

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Background A delayed initiation of tuberculosis treatment results in high morbidity, mortality, and increased person-to-person transmissions. The aim of this study was to assess treatment delay and its associated factors among adult drug resistant tuberculosis patients in the Amhara Regional State, Ethiopia. Methods An institution based cross-sectional study was conducted on all adult drug resistant tuberculosis patients who initiated treatment from September 2010 to December 2017. Data were collected from patient charts, registration books, and computer databases using abstraction sheets. The data were entered using Epi-info version 7 and exported to SPSS version 20 for analysis. Summary statistics, like means, medians, and proportions were used to present it. Binary logistic regression was fitted; Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was also computed. Variables with p -value < 0.05 in the multi-variable logistic regression model was declared as significantly associated with treatment delay. Results The median time to commence treatment after drug resistant tuberculosis diagnosis was 8 (IQR: 3–37) days. Being diagnosed by Line probe assay [AOR = 5.59; 95% CI: 3.48–8.98], Culture [AOR = 5.15; 95% CI: 2.53–10.47], and history of injectable anti-TB drugs [AOR = 2.12; 95% CI: 1.41–3.19] were associated with treatment delays. Conclusion Treatment delay was long, especially among patients diagnosed by Culture or LPA and those who had a prior history of injectable anti-TB drugs. That suggested that the need for universal accesses to rapid molecular diagnostic tests, such as Gene Xpert and the PMDT team were needed to promptly decide to minimize unnecessary delays.

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“…Given the high proportion of drug-resistant tuberculosis cases attributable to ongoing transmission [ 34 ] and the substantial delays often experienced in diagnosing and treating drug-resistant tuberculosis, the impact of improved case finding and diagnosis should be even greater. The Xpert MTB/RIF test has shortened the time to treatment initiation for multidrug-resistant tuberculosis in South Africa [ 35 , 36 ] and Latvia [ 37 ], and broader implementation of a rapid molecular test, even only for passive case detection, has been projected to avert substantial morbidity and mortality due to rifampin-resistant tuberculosis in settings like India [ 38 ]. Thus, for drug-resistant tuberculosis, newer diagnostic tools could substantially reduce transmission by linking patients to appropriate therapy more quickly in settings of active or passive case finding.…”

Section: Diagnostic and Case Finding Interventionsmentioning

confidence: 99%

Designing and Evaluating Interventions to Halt the Transmission of Tuberculosis

Dowdy

Grant

Dheda

et al. 2017

The Journal of Infectious Diseases

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To reduce the incidence of tuberculosis, it is insufficient to simply understand the dynamics of tuberculosis transmission. Rather, we must design and rigorously evaluate interventions to halt transmission, prioritizing those interventions most likely to achieve population-level impact. Synergy in reducing tuberculosis transmission may be attainable by combining interventions that shrink the reservoir of latent Mycobacterium tuberculosis infection (preventive therapy), shorten the time between disease onset and treatment initiation (case finding and diagnosis), and prevent transmission in key settings, such as the built environment (infection control). In evaluating efficacy and estimating population-level impact, cluster-randomized trials and mechanistic models play particularly prominent roles. Historical and contemporary evidence suggests that effective public health interventions can halt tuberculosis transmission, but an evidence-based approach based on knowledge of local epidemiology is necessary for success. We provide a roadmap for designing, evaluating, and modeling interventions to interrupt the process of transmission that fuels a diverse array of tuberculosis epidemics worldwide.

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Decreased Time to Treatment Initiation for Multidrug-Resistant Tuberculosis Patients after Use of Xpert MTB/RIF Test, Latvia

Abstract: This test decreased time to treatment initiation by 66%–84%.

Cited by 20 publications

References 17 publications

Time to appropriate treatment in patients with multidrug-resistant tuberculosis in South Korea: Are we still in 2010?

Time to appropriate treatment in patients with multidrug-resistant tuberculosis in South Korea: Are we still in 2010?

Treatment delay and associated factors among adults with drug resistant tuberculosis at treatment initiating centers in the Amhara regional state, Ethiopia

Designing and Evaluating Interventions to Halt the Transmission of Tuberculosis

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