Iruedo Joshua, O'Mahony Don, Mabunda Sikhumbuzo, Wright Graham, Cawe Busisiwe
Department of Family Medicine and Rural Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa.
Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa.
BMC Infect Dis. 2017 Jan 21;17(1):91. doi: 10.1186/s12879-017-2200-8.
There are significant delays in initiation of multidrug-resistant tuberculosis (MDR -TB) treatment. The Xpert MTB/RIF test has been shown to reduce the time to diagnosis and treatment of MDR-TB predominantly in urban centres. This study describes the time to treatment of MDR-TB and the effect of Xpert MTB/RIF on time to treatment in a deprived rural area in South Africa.
This was a retrospective cohort study analysing the medical records of patients diagnosed with MDR-TB in King Sabata Dalindyebo Sub-District between 2009 and 2014. Numerical data were reported using the Kruskal-Wallis and Wilcoxon sum rank tests and categorical data compared using the two-sample test of proportions.
Of the 342 patients with MDR-TB identified, 285 were eligible for analysis, of whom 145 (61.4%) were HIV positive. The median time from sputum collection to MDR-TB diagnosis was 27 days (IQR: 2-45) and differed significantly between diagnostic modalities: Xpert MTB/RIF, 1 day (IQR: 1-4; n = 114: p < 0.0001); Line Probe Assay 12 days (IQR: 8-21; n = 28; p < 0.0001); and culture/phenotypic drug sensitivity testing 45 days (IQR: 39-59; n = 143: p < 0.0001). The time from diagnosis to treatment initiation was 14 days (IQR: 8-27) and did not differ significantly between diagnostic modality. The median time from sputum collection to treatment initiation was 49 days (IQR: 20-69) but differed significantly between diagnostic modalities: Xpert MTB/RIF, 18 days (IQR: 11-27; n = 114; p < 0.0001); Line Probe Assay 29 days (IQR: 14.5-53; n = 28; p < 0.0001); and culture/phenotypic drug sensitivity, 64 days (IQR: 50-103; n = 143: P < 0.0001). Age, sex and HIV status did not influence the time intervals.
Xpert MTB/RIF significantly reduced the time to MDR-TB treatment in a deprived rural setting as a result of a reduced time to diagnosis. However, the national target of five days was not achieved. Further research is needed to explore and address programmatic and patient-related challenges contributing to delayed treatment initiation.
耐多药结核病（MDR-TB）治疗的启动存在显著延迟。Xpert MTB/RIF检测已被证明主要在城市中心地区可缩短耐多药结核病的诊断和治疗时间。本研究描述了南非一个贫困农村地区耐多药结核病的治疗时间以及Xpert MTB/RIF对治疗时间的影响。
这是一项回顾性队列研究，分析了2009年至2014年期间在萨巴塔·达林迪耶博国王分区被诊断为耐多药结核病的患者的病历。数值数据采用Kruskal-Wallis检验和Wilcoxon秩和检验进行报告，分类数据采用两样本比例检验进行比较。
在确定的342例耐多药结核病患者中，285例符合分析条件，其中145例（61.4%）为HIV阳性。从痰液采集到耐多药结核病诊断的中位时间为27天（四分位间距：2-45天），不同诊断方法之间存在显著差异：Xpert MTB/RIF为1天（四分位间距：1-4天；n = 114：p < 0.0001）；线性探针分析为12天（四分位间距：8-21天；n = 28：p < 0.0001）；培养/表型药物敏感性检测为45天（四分位间距：39-59天；n = 143：p < 0.0001）。从诊断到治疗开始的时间为14天（四分位间距：8-27天），不同诊断方法之间无显著差异。从痰液采集到治疗开始的中位时间为49天（四分位间距：20-69天），但不同诊断方法之间存在显著差异：Xpert MTB/RIF为18天（四分位间距：11-27天；n = 114：p < 0.0001）；线性探针分析为29天（四分位间距：14.5-53天；n = 28：p < 0.0001）；培养/表型药物敏感性检测为64天（四分位间距：50-103天；n = 143：P < 0.0001）。年龄、性别和HIV状态不影响时间间隔。
由于诊断时间缩短，Xpert MTB/RIF在贫困农村地区显著缩短了耐多药结核病的治疗时间。然而，未达到国家规定的5天目标。需要进一步研究以探索和解决导致治疗启动延迟的项目和患者相关挑战。
