Rapid drug susceptibility testing and treatment outcomes for multidrug-resistant tuberculosis in Peru

Obregon, George; Zevallos, Karine; Alarcón, V; Puyén, Zully M.; Inagaki, Osamu; Mendoza-Ticona, Alberto; Alarcón-Arrascue, E; Heldal, Einar; Moore, David

doi:10.5588/ijtld.17.0894

Cited by 5 publications

(8 citation statements)

References 7 publications

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“…In 2017, the global RR-TB treatment success rate was a mere 55%, 3 with diagnostic and/or therapeutic delays associated with poorer treatment outcome and pre-treatment loss to follow-up (LTFU). 2,[6][7][8][9][10][11][12][13] However, evidence on the effect of shortened delays on RR-TB mortality is lacking. 14 In Rwanda, the first patients with RR-TB were documented in 1989 at the Kigali University Hospital, Kigali, Rwanda.…”

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confidence: 99%

Reduction of diagnostic and treatment delays reduces rifampicin-resistant tuberculosis mortality in Rwanda

Ngabonziza

Habimana

Decroo

et al. 2020

int j tuberc lung dis

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SETTING: In 2005, in response to the increasing prevalence of rifampicin-resistant tuberculosis (RR-TB) and poor treatment outcomes, Rwanda initiated the programmatic management of RR-TB, including expanded access to systematic rifampicin drug susceptibility testing (DST) and standardised treatment.OBJECTIVE: To describe trends in diagnostic and treatment delays and estimate their effect on RR-TB mortality.DESIGN: Retrospective analysis of individual-level data including 748 (85.4%) of 876 patients diagnosed with RR-TB notified to the World Health Organization between 1 July 2005 and 31 December 2016 in Rwanda. Logistic regression was used to estimate the effect of diagnostic and therapeutic delays on RR-TB mortality.RESULTS: Between 2006 and 2016, the median diagnostic delay significantly decreased from 88 days to 1 day, and the therapeutic delay from 76 days to 3 days. Simultaneously, RR-TB mortality significantly decreased from 30.8% in 2006 to 6.9% in 2016. Total delay in starting multidrug-resistant TB (MDR-TB) treatment of more than 100 days was associated with more than two-fold higher odds for dying. When delays were long, empirical RR-TB treatment initiation was associated with a lower mortality.CONCLUSION: The reduction of diagnostic and treatment delays reduced RR-TB mortality. We anticipate that universal testing for RR-TB, short diagnostic and therapeutic delays and effective standardised MDR-TB treatment will further decrease RR-TB mortality in Rwanda.

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confidence: 99%

Reduction of diagnostic and treatment delays reduces rifampicin-resistant tuberculosis mortality in Rwanda

Ngabonziza

Habimana

Decroo

et al. 2020

int j tuberc lung dis

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“…Varias cohortes prospectivas y retrospectivas en Sudáfrica han demostrado que la introducción de la prueba Xpert ® no mejoró el resultado del tratamiento y la proporción de PEES continúa siendo alta (25, 26). Este efecto de mayor PEES cuando se introducen pruebas rápidas también se ha visto en Perú, donde luego de la implementación de las pruebas MODS ® y Genotype MTBDRplus ® se ha producido el incremento de la tasa de la cura y reducción de la mortalidad por TB, pero también un aumento de la PEES como condición de egreso de los pacientes con TB RMD (27).…”

Section: Discussionunclassified

Pérdida en el seguimiento de pacientes tratados por tuberculosis resistente a rifampicina o multidrogorresistente en Ecuador

Tatés-Ortega

Alvarez

López

et al. 2019

Revista Panamericana De Salud Pública

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Objetivo. Determinar la incidencia de pérdida en el seguimiento (PEES) en pacientes tratados por tuberculosis (TB) resistente a rifampicina o multidrogorresistente (TB-RR/MDR) y los factores asociados a esta condición de egreso en Ecuador. Métodos. Estudio de cohorte retrospectivo de pacientes con TB-RR/MDR tratados con el esquema de 18 a 24 meses de la Organización Mundial de la Salud en 2014 y 2015 notificados al Ministerio de Salud del Ecuador. Se determinó la incidencia de PEES y se compararon las características clínicas y epidemiológicas de los casos egresados como PEES versus los egresados como éxito de tratamiento. Se analizó la sobrevida con regresión de Cox para evaluar factores asociados a PEES. Resultados. De 328 casos, 270 (82,3%) fueron analizados porque tuvieron condición de egreso notificada. El egreso como PEES fue 39,6% y el éxito de tratamiento 50,4%. Los factores de riesgo asociados a PEES fueron: antecedente de egreso como PEES en episodio previo de TB, cociente de riesgos instantáneos (HR, por sus siglas en inglés): 2,96 (1,53-5,73), P < 0,001; adicción al alcohol o drogas, HR: 2,82 (1,10-7,23), P = 0,031 y tener diagnóstico por la prueba Xpert® (TB-RR), HR: 1,53 (1,0-2,35), P = 0,048. Del total de PEES, 43% ocurrió después de nueve meses de tratamiento. Conclusión. La incidencia de PEES en pacientes con TB-RR/MDR en Ecuador está por encima del promedio en la Región de las Américas. Los tres factores identificados refuerzan la implementación de regímenes acortados y atención centrada en el paciente, siguiendo la Estrategia Fin a la Tuberculosis.

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“…Numerous studies have shown that mDST could shorten the time to diagnose MDR-TB, thereby reducing the time to MDR-TB treatment initiation and improving the outcomes of MDR-TB patients. [6][7][8][9][10][11][12][13][14][15][16] As new diagnostics and new drugs become available, the paradigm of MDR-TB treatment is changing from a hierarchical drug combination based on pDST to the immediate initiation of a new regimen based on mDST. 17 mDST has become a critical element of MDR-TB management, and its coverage is one of the indicators used to evaluate the National TB Control Program.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of Molecular Drug Susceptibility Testing on the Time to Multidrug-resistant Tuberculosis Treatment Initiation

et al. 2020

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Background: The purpose of this study was to evaluate the current status and trends in the coverage of molecular drug susceptibility testing (mDST), and the impact of mDST on the time to multidrug-resistant tuberculosis (MDR-TB) treatment initiation in Korea. Methods: We included confirmed rifampin-resistant (RR)/MDR-TB patients who submitted application forms for novel drug uses to the National TB Expert Review Committee from September 1, 2016 to November 30, 2019. We retrospectively reviewed their medical records. Results: Of the 621 MDR/RR-TB patients, mDST was performed in 442 (71.2%); Xpert MTB/ RIF (Xpert) alone in 109 (17.6%), MTBDRplus line probe assay (LPA) alone in 199 (32.0%), and both Xpert and LPA in 134 (21.6%) patients. The coverage rate of mDST has gradually increased to 70% in

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Rapid drug susceptibility testing and treatment outcomes for multidrug-resistant tuberculosis in Peru

Cited by 5 publications

References 7 publications

Reduction of diagnostic and treatment delays reduces rifampicin-resistant tuberculosis mortality in Rwanda

Reduction of diagnostic and treatment delays reduces rifampicin-resistant tuberculosis mortality in Rwanda

Pérdida en el seguimiento de pacientes tratados por tuberculosis resistente a rifampicina o multidrogorresistente en Ecuador

Impact of Molecular Drug Susceptibility Testing on the Time to Multidrug-resistant Tuberculosis Treatment Initiation

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