Diagnosis and treatment of TB patients with rifampicin resistance detected using Xpert<sup>®</sup> MTB/RIF in Zimbabwe

Charambira, Kelvin; Adè, S.; Harries, Anthony; Ncube, Ronald; Zishiri, C.; Sandy, Charles; Mutunzi, H.; Takarinda, Kudakwashe C; Owiti, P.; Mafaune, Patron Titsha; Chonzi, Prosper

doi:10.5588/pha.16.0005

Cited by 10 publications

(10 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Many countries still like to confirm their RR-TB Xpert results with conventional culture and drug sensitivity testing (CDST) in national reference laboratories, and this requires the transportation of sputum specimens from peripheral health facilities. Wherever this system has been assessed, it does not function 42 – 45 , and transportation is the major bottleneck. Other obstacles include the formation of committees to approve MDR-TB treatment and a battery of hematological and biochemical tests which are considered necessary in all settings before treatment can be started.…”

Section: Diagnose and Promptly Treat Drug-resistant Tuberculosismentioning

confidence: 99%

What can National TB Control Programmes in low- and middle-income countries do to end tuberculosis by 2030?

et al. 2018

View full text Add to dashboard Cite

The international community has committed to ending the tuberculosis (TB) epidemic by 2030. This will require multi-sectoral action with a focus on accelerating socio-economic development, developing and implementing new tools, and expanding health insurance coverage. Within this broad framework, National TB Programmes (NTPs) are accountable for delivering diagnostic, treatment, and preventive services. There are large gaps in the delivery of these services, and the aim of this article is to review the crucial activities and interventions that NTPs must implement in order to meet global targets and milestones that will end the TB epidemic. The key deliverables are the following: turn End TB targets and milestones into national measurable indicators to make it easier to track progress; optimize the prompt and accurate diagnosis of all types of TB; provide rapid, complete, and effective treatment to all those diagnosed with TB; implement and monitor effective infection control practices; diagnose and treat drug-resistant TB, associated HIV infection, and diabetes mellitus; design and implement active case finding strategies for high-risk groups and link them to the treatment of latent TB infection; engage with the private-for-profit sector; and empower the Central Unit of the NTP particularly in relation to data-driven supportive supervision, operational research, and sustained financing. The glaring gaps in the delivery of TB services must be remedied, and some of these gaps will require new paradigms and ways of working which include patient-centered and higher-quality services. There must also be fast-track ways of incorporating new diagnostic, treatment, and prevention tools into program activities so as to rapidly reduce TB incidence and mortality and meet the goal of ending TB by 2030.

show abstract

Section: Diagnose and Promptly Treat Drug-resistant Tuberculosismentioning

confidence: 99%

What can National TB Control Programmes in low- and middle-income countries do to end tuberculosis by 2030?

et al. 2018

View full text Add to dashboard Cite

show abstract

“…In Zimbabwe, the submission rate of sputum samples for culture and DST at two healthcare centres was 70%, of which only half reached the laboratory and were processed. [34] Possible explanations for our results are that patients may have been transferred to the referral centre before a confirmatory specimen was submitted, the patient may no longer have been expectorating sputum, or the attending doctor may not have known the recommended protocol. Premature discharging of patients is a direct result of limited hospital beds and a high patient demand at our centre.…”

Section: Discussionmentioning

confidence: 97%

“…Possible explanations include a delay in obtaining a sputum sample from the patient, delays in transport, registration, or processing of the specimen by the laboratory, and sputum samples that may be lost in transit. [34] A contemporary investigation of the time to obtaining a result would be beneficial. After patients who were discharged or had died before their result became available were taken into account, 66% of the remaining 53 patients were isolated with a mean time of 4 days after being admitted.…”

Section: Discussionmentioning

confidence: 99%

The prevalence and management of rifampicin-resistant tuberculosis among adults at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa

Karstaedt

Sahid

2017

S Afr Res J

View full text Add to dashboard Cite

Background. Early effective management of drug-resistant tuberculosis (TB) is important for the patient, and for infection control. The Xpert MTB/RIF (Cepheid, USA) assay detects Mycobacterium tuberculosis DNA and the presence of rifampicin resistance. Objective. To assess the prevalence and initial management of rifampicin-resistant pulmonary TB (PTB), confirmed by the Xpert MTB/ RIF assay, in hospitalised adult patients. Methods. This retrospective descriptive study assessed adult patients from March 2011 to February 2013. Data was obtained from the National Health Laboratory Service database and patient records. Management comprised the submission of additional confirmatory sputum tests, initiation of appropriate anti-TB drug therapy, patient isolation, and proper referral. Results. The prevalence of rifampicin resistance was 10.6% (n=77) of 729 positive assays. The initial management was assessed for 70 patients with complete records. However, of these 70 patients, 12 patients had been discharged and 5 patients had died prior to receiving their results. The management of the total cohort, and of the 53 remaining inpatients, was analysed separately. The overall confirmatory sputum submission rates were 76%, 60%, 60% and 26% for TB microscopy, Line Probe Assay, TB culture, and drug-susceptibility testing, respectively, and 87%, 72%, 68% and 30%, respectively for the 53 remaining patients. Overall, 33% of patients received appropriate anti-TB treatment, 50% were isolated, and 49% were appropriately referred. For the 53 remaining patients, 43% received appropriate drug treatment, 66% were isolated, 64% were appropriately referred, and 19% were not referred. The inpatient mortality rate was 19%. Conclusions. Rifampicin-resistant TB prevalence in-hospital was more than double the national rate. The initial management of patients with rifampicin-resistant PTB was substandard. Submission of paired sputum samples and educating healthcare professionals and healthcare users are of paramount importance to improve the management of drug-resistant TB.

show abstract

“…This is consistent with findings from a previous study in 2014 in two Zimbabwe provinces in which the proportion of specimens that reached the NRLs was 53%. 23 We do not know the precise reasons for this suboptimal performance, but they could include health care workers not adhering to policy guidelines that stipulate all sputum specimens for re-treatment TB patients be sent for CDST, a preference to just send specimens that are rifampicin resistant, unreliable sputum specimen transportation systems and poor administrative systems at the NRLs. Research, especially of a qualitative nature, is needed to find the answers to these questions.…”

Section: Discussionmentioning

confidence: 99%

How has the Zimbabwe mycobacterial culture and drug sensitivity testing system among re-treatment tuberculosis patients functioned during the scale-up of the Xpert MTB/RIF assay?

Timire

Takarinda

Harries

et al. 2018

Transactions of the Royal Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

BackgroundIn Zimbabwe, while the Xpert MTB/RIF assay is being used for diagnosing tuberculosis and rifampicin-resistance, re-treatment tuberculosis (TB) patients are still expected to have culture and drug sensitivity testing (CDST) performed at national reference laboratories for confirmation. The study aim was to document the Xpert MTB/RIF assay scale-up and assess how the CDST system functioned for re-treatment TB patients.MethodsWe performed an ecologic study using national aggregate data.ResultsUse of the Xpert MTB/RIF assay increased from 11 829 to 68 153 between 2012 and 2016. Xpert assays worked well, with successful tests in more than 90% of cases, TB detection rates at 15–17% and rifampicin resistance in <10%. During Xpert scale-up, the number of sputum specimens from re-treatment TB patients reaching national reference laboratories for CDST increased from 12% to 51%. In terms of laboratory performance, culture contamination increased from 3% to 17%, positive cultures from 13% to 17% and successful CDST from 6% to 14%: the proportion of CDST showing any resistance to rifampicin averaged 44%. From 2009 to 2016, the proportion of notified re-treatment TB patients with successful CDST increased from <1% to 7%.ConclusionsWhile components of Zimbabwe’s CDST system for re-treatment TB patients showed some changes during the scale-up of the Xpert MTB/RIF assay, overall performance was poor. The country must either invest in improving CDST performance or in advanced molecular diagnostic technology.

show abstract

Diagnosis and treatment of TB patients with rifampicin resistance detected using Xpert^® MTB/RIF in Zimbabwe

Cited by 10 publications

References 15 publications

What can National TB Control Programmes in low- and middle-income countries do to end tuberculosis by 2030?

What can National TB Control Programmes in low- and middle-income countries do to end tuberculosis by 2030?

The prevalence and management of rifampicin-resistant tuberculosis among adults at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa

How has the Zimbabwe mycobacterial culture and drug sensitivity testing system among re-treatment tuberculosis patients functioned during the scale-up of the Xpert MTB/RIF assay?

Contact Info

Product

Resources

About

Diagnosis and treatment of TB patients with rifampicin resistance detected using Xpert® MTB/RIF in Zimbabwe

Cited by 10 publications

References 15 publications

What can National TB Control Programmes in low- and middle-income countries do to end tuberculosis by 2030?

What can National TB Control Programmes in low- and middle-income countries do to end tuberculosis by 2030?

The prevalence and management of rifampicin-resistant tuberculosis among adults at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa

How has the Zimbabwe mycobacterial culture and drug sensitivity testing system among re-treatment tuberculosis patients functioned during the scale-up of the Xpert MTB/RIF assay?

Contact Info

Product

Resources

About

Diagnosis and treatment of TB patients with rifampicin resistance detected using Xpert^® MTB/RIF in Zimbabwe