Modeling the patient and health system impacts of alternative xpert® MTB/RIF algorithms for the diagnosis of pulmonary tuberculosis in Addis Ababa, Ethiopia

Tesfaye, Abraham; Fiseha, Daniel; Assefa, Dawit; Klinkenberg, Eveline; Balanco, Silvia; Langley, Ivor

doi:10.1186/s12879-017-2417-6

Cited by 12 publications

(15 citation statements)

References 13 publications

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“…Of the remaining 33, twenty studies were excluded due to lack of effectiveness data [ S4 Table ]. Finally this review included 13 studies from which data were extracted; four of the included studies compared LED-FM with ZN [ 13 , 25 , 26 , 27 ] and seven studies compared ZN with GeneXpert [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ].…”

Section: Resultsmentioning

confidence: 99%

“…Out of the 13 studies, seven were conducted in Africa [ 25 , 28 , 31 , 32 , 34 , 35 , 36 ] of which four were from South Africa [ 25 , 31 , 32 , 36 ], one was a multi-centric study which included Botswana, Lesotho, Namibia, South Africa and Swaziland [ 34 ], one from Zambia [ 28 ] and one from Ethiopia [ 35 ] ( Table 1 ). Four studies were conducted in Asia with one each from India, China, Hong Kong and Thailand [ 13 , 26 , 27 , 30 ].…”

Section: Resultsmentioning

confidence: 99%

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Cost-effectiveness of GeneXpert and LED-FM for diagnosis of pulmonary tuberculosis: A systematic review

Sagili¹,

Muniyandi

Nilgiriwala

et al. 2018

PLoS ONE

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BackgroundEarly and accurate diagnosis of tuberculosis is a priority for TB programs globally to initiate treatment early and improve treatment outcomes. Currently, Ziehl–Neelsen (ZN) stain-based microscopy, GeneXpert and Light Emitting Diode-Fluorescence Microscopy (LED-FM) are used for diagnosing pulmonary drug sensitive tuberculosis. Published evidence synthesising the cost-effectiveness of these diagnostic tools is scarce.MethodologyPubMed, EMBASE and Cost-effectiveness analysis registry were searched for studies that reported on the cost-effectiveness of GeneXpert and LED-FM, compared to ZN microscopy for diagnosing pulmonary TB. Risk of bias was assessed independently by four authors using the Consensus Health Economic Criteria (CHEC) extended checklist. The data variables included the study settings, population, type of intervention, type of comparator, year of study, duration of study, type of study design, costs for the test and the comparator and effectiveness indicators. Incremental cost-effectiveness ratio (ICER) was used for assessing the relative cost-effectiveness in this review.ResultsOf the 496 studies identified by the search, thirteen studies were included after removing duplicates and studies that did not fulfil inclusion criteria. Four studies compared LED-FM with ZN and nine studies compared GeneXpert with ZN. Three studies used patient cohorts and eight were modelling studies with hypothetical cohorts used to evaluate cost-effectiveness. All these studies were conducted from a health system perspective, with four studies utilising cost utility analysis. There were considerable variations in costing parameters and effectiveness indicators that precluded meta-analysis. The key findings from the included studies suggest that LED-FM and GeneXpert may be cost effective for pulmonary TB diagnosis from a health system perspective.ConclusionOur review identifies a consistent trend of the cost effectiveness of LED-FM and GeneXpert for pulmonary TB diagnosis in different countries with diverse context of socio-economic condition, HIV burden and geographical distribution. However, all the studies used different parameters to estimate the impact of these tools and this underscores the need for improving the methodological issues related to the conduct and reporting of cost-effectiveness studies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Cost-effectiveness of GeneXpert and LED-FM for diagnosis of pulmonary tuberculosis: A systematic review

Sagili¹,

Muniyandi

Nilgiriwala

et al. 2018

PLoS ONE

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“…GeneXpert machines are therefore needed to improve their distribution. Tesfaye et al [17] also observed that there is shortage and poor distribution of GeneXpert machines in Sub-Saharan Africa and suggests that other cheaper alternatives are needed.…”

Section: Discussionmentioning

confidence: 99%

Health system challenges affecting the implementation of isoniazid preventive therapy in people living with HIV in Lesotho

Mugomeri¹,

Olivier²,

Heever³

2018

HIV & AIDS Review

153

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Introduction: The six-month course of isoniazid preventive therapy (IPT) has been demonstrated to have significant benefits in mitigating the occurrence of tuberculosis (TB), particularly in high TB burden settings. However, its implementation in Sub-Saharan countries remains subdued for obscure reasons. This study investigated the factors inhibiting IPT uptake in the sub-Saharan country of Lesotho, which has one of the highest rates of TB incidences globally. Material and methods: Data were obtained from 46 healthcare workers, key informants at the Ministry of Health of Lesotho, and representatives of partner organizations, who were purposively selected for their roles in IPT implementation. Data were coded to identify themes, and the emerging themes were benchmarked to previous typologies for evaluating the implementation of best practices in health interventions, namely effectiveness, reach, sustainability, and adaptation. Each major theme was further linked to the World Health Organization's 'six building blocks of a health system'. Results: Challenges affecting the implementation of IPT were as follows: ineffective TB screening due to challenged decentralization of human immunodeficiency virus (HIV)/TB services, late detection of side effects linked to weak monitoring systems, and inefficient health information systems. Further challenges in the health system included interrupted supply chains due to insufficient health system financing, while inadequate healthcare workers' education on IPT implementation was also noted. Conclusions: These findings indicate that a wide spectrum of challenges has affected the implementation of IPT in Lesotho, and this indicates the need for 'health systems approach' to the implementation of IPT in Lesotho and other countries with similar challenges.

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“…Patients used to be diagnosed for TB using the spotmorning-spot smear strategy, but now they are diagnosed using the spot-spot strategy and chest radiographs [10].…”

Section: Study Settingmentioning

confidence: 99%

Treatment outcomes of tuberculosis patients under directly observed treatment short-course at Debre Tabor General Hospital, northwest Ethiopia: nine-years retrospective study

et al. 2018

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Background: Data regarding tuberculosis (TB) treatment outcomes, proportion of TB/HIV co-infection and associated factors have been released at different TB treatment facilities in Ethiopia and elsewhere in the world as part of the auditing and surveillance service. However, these data are missing for the TB clinic offering directly observed treatment short-course (DOTs) at Debre Tabor General Hospital (DTGH). Methods: The authors analysed the records of 985 TB patients registered at the DTGH from September 2008 to December 2016. Data on patients' sex, age, type of TB, and treatment outcomes were extracted from the TB treatment registration logbook. The treatment outcome of patients was categorized according to the National TB and Leprosy Control Program guidelines: cured, treatment completed, treatment failed, died, and not evaluated (transferred out and unknown cases). Results: Around half of the registered patients were males (516, 52.4%). In terms of TB types, 381 (38.7%), 241 (24.5%), and 363 (36.9%) patients had smear-negative pulmonary TB, smear-positive pulmonary TB, and extra pulmonary TB, respectively. Six hundred and seventy-two patients (90.1%) had successful treatment outcomes (cured and treatment completed), while 74 patients (9.9%) had unsuccessful treatment outcomes (death and treatment failure).TB treatment outcome was not associated with age, sex, type and history of TB, or co-infection with HIV (P > 0.05). The proportion of TB/HIV co-infection was at 24.2%, and these were found to be significantly associated with the age groups of 25-34, 35-44 and ≥65 years:(aOR: 0.44; 95% CI: 0.25-0.8), (aOR: 0.39; 95% CI: 0.20-0.70), (aOR: 4.2; 95% CI: 1.30-12.9), respectively. Conclusions: The proportion of patients with successful treatment outcomes was above the World Health Organization target set for Millennium Development Goal of 85% and in line with that of the global milestone target set at > 90% for 2025. Relatively higher proportions of transfer-out cases were recorded in the present study. Similarly, the proportion of TB/HIV co-infection cases was much higher than the national average of 8%.Thus, the health facility under study should develop strategies to record the final treatment outcome of transfer-out cases. In addition, strategies to reduce the burden of TB/HIV co-infection should be strengthened.

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Modeling the patient and health system impacts of alternative xpert® MTB/RIF algorithms for the diagnosis of pulmonary tuberculosis in Addis Ababa, Ethiopia

Cited by 12 publications

References 13 publications

Cost-effectiveness of GeneXpert and LED-FM for diagnosis of pulmonary tuberculosis: A systematic review

Cost-effectiveness of GeneXpert and LED-FM for diagnosis of pulmonary tuberculosis: A systematic review

Health system challenges affecting the implementation of isoniazid preventive therapy in people living with HIV in Lesotho

Treatment outcomes of tuberculosis patients under directly observed treatment short-course at Debre Tabor General Hospital, northwest Ethiopia: nine-years retrospective study

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