Department of Family Medicine, University of KwaZulu-Natal and Medical Research Council TB Unit, Durban.
S Afr Med J. 2012 May 8;102(6 Pt 2):360-2. doi: 10.7196/samj.5361.
Background. According to the National Department of Health (NDoH) guidelines, patients diagnosed with MDR TB must be referred to a specialised treatment centre for initiation of effective therapy. MDR TB is difficult to diagnose and the centralised referral model is beset with challenges that contribute to treatment delays, increased patient morbidity and mortality, and MDR TB nosocomial transmission. Culture and DST takes 8 weeks or longer to obtain results while line probe assays (LPAs) can give a result in hours. LPAs and the GeneXpert MTB/Rif (GX) are ground-breaking discoveries for TB diagnosis. However, they are not easily accessible or available to those needing it, so culture and sensitivity testing remains the gold standard for diagnosis. Aim. This study aimed to assess the delay in the initiation of MDR TB treatment and profiled the patients being referred to a specialised drug-resistant treatment centre in KwaZulu-Natal. Results. Of all the patients, 75% referred showed a mean delay of 12.4 weeks from the date of sputum collection for culture and drug sensitivity testing to the start of treatment. Most of the patients were symptomatic for TB and HIV-positive. Discussion. Our findings suggest that current policy on the initiation of effective treatment needs urgent revision. Staff should be appropriately trained in LPA and GX technology to reduce delays in initiating treatment for MDR TB. The NDoH's plans for rapid diagnosis and reducing the treatment burden on centralised MDR TB management facilities are in the early phases of implementation and will take years to achieve favourable and significant outcomes. Conclusion. There is a significant delay in initiating definitive management for MDR TB.
背景。根据国家卫生部（NDoH）的指导方针，诊断为耐多药结核病（MDR-TB）的患者必须转至专门的治疗中心，以开始进行有效的治疗。MDR-TB 的诊断具有难度，集中转诊模式存在各种挑战，导致治疗延误、患者发病率和死亡率上升，以及 MDR-TB 院内传播。培养和药敏试验需要 8 周或更长时间才能得出结果，而线探针检测（LPA）可在数小时内得出结果。LPA 和 GeneXpert MTB/Rif（GX）是结核病诊断的突破性发现。然而，它们并非易于获取或供需要的人使用，因此培养和药敏试验仍然是诊断的金标准。目的。本研究旨在评估 MDR-TB 治疗开始的延迟，并对转至夸祖鲁-纳塔尔省专门的耐药治疗中心的患者进行分析。结果。所有转至中心的患者中，75%的患者从痰液采集进行培养和药敏试验到开始治疗的平均延迟时间为 12.4 周。大多数患者具有结核病和 HIV 阳性的症状。讨论。我们的发现表明，目前关于启动有效治疗的政策急需修订。应适当培训工作人员以掌握 LPA 和 GX 技术，以减少 MDR-TB 治疗开始的延迟。NDoH 加快诊断和减轻集中 MDR-TB 管理设施治疗负担的计划正处于早期实施阶段，需要数年时间才能取得有利和显著的结果。结论。MDR-TB 的起始确定性治疗存在显著延迟。
