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

doi:10.1371/journal.pone.0181238

Cited by 11 publications

(21 citation statements)

References 26 publications

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“…The majority (78%; 540/686) of patients in our cohorts initiated treatment at a decentralized, outpatient DR-TB center, whereas the national cohort study included patients from both decentralized, outpatient and centralized, inpatient treatment facilities. The model of care has been shown to contribute to a decrease in time to treatment initiation, with outpatient sites demonstrating significantly lower time to treatment initiation compared to centralized, inpatient sites [3].…”

Section: Discussionmentioning

confidence: 99%

“…Despite improved linkage to care and a reduction in pre-treatment mortality, pre-treatment loss to follow up remained high (17.5 and 22.4%). Interventions such as the implementation of decentralized TB treatment and Xpert MTB/RIF thus do not appear sufficient to address alarmingly high rates of pre-treatment loss [3]. TB services could benefit from the implementation of a unique patient identifier so that health care workers can focus tracing efforts on patients who are “truly lost” and not waste efforts or resources on patients who have moved or transferred out of the city and initiated care at another facility, in the same or a different province.…”

Section: Discussionmentioning

confidence: 99%

“…1). Details of the matching and the validation of the matching algorithm have been described before [3]. Treatment start dates were obtained from treatment registers.…”

Section: Methodsmentioning

confidence: 99%

“…Study staff worked closely with facilities and the COJ to verify and correct patient information (e.g. to correctly record DR-TB registration numbers in facility registers and query specific cases where diagnosis date or treatment initiation date preceded the sputum collection date) [3]. Medical records could only be queried for patients who initiated DR-TB treatment at one of the city’s four treatment sites.…”

Section: Methodsmentioning

confidence: 99%

“…To this end, the South African National TB program launched decentralized DR-TB services and the national use of Cepheid’s Xpert MTB/RIF in 2011. Decentralization of services allows patients with DR-TB to be treated as outpatients, increases the number of treatment facilities, reduces cost, and improves time to treatment initiation [3–5]. Xpert MTB/RIF is a rapid molecular test that provides same day diagnosis of TB and rifampicin susceptibility.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Xpert MTB/RIF and decentralized care on linkage to care and drug-resistant tuberculosis treatment outcomes in Johannesburg, South Africa

Evans

Sineke

Schnippel

et al. 2018

BMC Health Serv Res

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BackgroundIn 2011, South Africa improved its ability to test for rifampicin-resistant TB (RR-TB) by introducing GeneXpert MTB/RIF. At the same time, the South African National TB program adopted a policy decentralized, outpatient treatment for drug resistant (DR-) TB. We aim to analyze the impact of these changes on linkage to care and DR-TB treatment outcomes.MethodsWe retrospectively matched adult patients diagnosed with laboratory-confirmed RR-TB in Johannesburg from 07/2011–06/2012 (early cohort) and 07/2013–06/2014 (late cohort) with records of patients initiating DR-TB treatment at one of the city’s four public sector treatment sites. We determine the proportion of persons diagnosed with RR-TB who initiated DR-TB treatment and report time to treatment initiation (TTI) before and after the implementation of Xpert MTB/RIF roll-out in Johannesburg, South Africa. We conducted a sub-analysis among those who initiated DR-TB treatment at the decentralized outpatient DR-TB centers to determine if delays in treatment initiation have a subsequent impact on treatment outcomes.ResultsFive hundred ninety four patients were enrolled in the early cohort versus 713 in the late cohort. 53.8 and 36.8% of patients were diagnosed with multi-drug resistant TB in the early and late cohorts, respectively. The proportion of RR-TB confirmed cases diagnosed by Xpert MTB/RIF increased from 43.4 to 60.5% between the early and late cohorts, respectively. The proportion who initiated treatment increased from 43.1% (n = 256) to 60.3% (n = 430) in the late cohort. Pre-treatment mortality during the early and the late cohort reduced significantly from 17.5 to 5.8% while lost to follow-up remained high.Although TTI reduced by a median of 19 days, from 33 days (IQR 12–52) in the early cohort to 14 days (IQR 7–31) in the late cohort, this did not translate to improved treatment outcomes and we found no difference in terms of treatment success or on-treatment mortality for those that initiated without delay vs. those that deferred initiation.ConclusionPre-treatment mortality reduced significantly during late Xpert MTB/RIF coverage but there was no significant difference after treatment was initiated. Despite improvements there is still a significant diagnosis and treatment gap for patients diagnosed with RR-TB and improving treatment outcomes remains critical.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3762-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…1). Details of the matching and the validation of the matching algorithm have been described before [3]. Treatment start dates were obtained from treatment registers.…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of Xpert MTB/RIF and decentralized care on linkage to care and drug-resistant tuberculosis treatment outcomes in Johannesburg, South Africa

Evans

Sineke

Schnippel

et al. 2018

BMC Health Serv Res

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Factors affecting time to treatment initiation after diagnosis for multidrug‐resistant/rifampicin‐resistant tuberculosis patients: A mixed‐methods study in Jakarta, Indonesia

Silitonga

Jiang

Wyatt

et al. 2022

Tropical Med Int Health

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Objective: To investigate the time to treatment initiation (TTI) for multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) patients after diagnosis in Indonesia and biological, psychological and social factors associated with the time interval. Methods: This study was conducted in Persahabatan Hospital, Jakarta using a mixedmethods approach. Registry data and medical records of MDR/RR-TB patients were collected and matched (hospital dataset), and linked with psychosocial assessment results (linked dataset). Descriptive analysis was conducted to understand patient characteristics and the distribution of TTI after RR-TB diagnosis by GeneXpert. Generalised linear regression was used to analyse factors associated with delay duration, and logistic regression to explore factors associated with the delay longer than the median duration for both datasets (basic vs. extended model). In-depth interviews were conducted with patients and healthcare workers to understand the procedure of treatment initiation and how different factors led to delay. Results: The hospital dataset included 275 patient-matched cases, and 188 were further linked with psychosocial assessment results. The median time interval was 24 days [interquartile range (IQR) 23.5] and 26 days (IQR 21.25), respectively. Regression analysis showed that in the extended model, comorbidities (exp [coefficient] = 1.93), unemployment (exp [coefficient] = 1.80) and poor knowledge of MDR/RR-TB (exp (coefficient) = 1.67) seemed to have the strongest effects on prolonging the time interval (p < 0.05). Unsuccessful TB treatment history was the only factor that significantly increased the risk of delay longer than the median duration (p < 0.05) in the basic model, while none of the factors were significant in the extended model. The qualitative study identified provider-side factors (centralised service provision and insufficient human resources) and patient-side factors (physical weakness, psychological stress and financial concern) associated with treatment delay. Conclusion: MDR/RR-TB patients in Persahabatan Hospital, Jakarta, Indonesia waited around 25 days for treatment initiation after RR-TB diagnosis. Health system solutions are needed to address challenges facing both MDR/RR-TB patients and healthcare providers to reduce delay in treatment initiation.K E Y W O R D S drug-resistant tuberculosis, health system, Indonesia, treatment initiation delay Permata Silitonga and Weixi Jiang contributed equally as first authors.

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

Cited by 11 publications

References 26 publications

Impact of Xpert MTB/RIF and decentralized care on linkage to care and drug-resistant tuberculosis treatment outcomes in Johannesburg, South Africa

Impact of Xpert MTB/RIF and decentralized care on linkage to care and drug-resistant tuberculosis treatment outcomes in Johannesburg, South Africa

Factors affecting time to treatment initiation after diagnosis for multidrug‐resistant/rifampicin‐resistant tuberculosis patients: A mixed‐methods study in Jakarta, Indonesia

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

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