Mnyambwa Nicholaus Peter, Lekule Issack, Ngadaya Esther S, Kimaro Godfather, Petrucka Pammla, Kim Dong-Jin, Lymo Johnson, Kazwala Rudovick, Mosha Fausta, Mfinanga Sayoki G
School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania.
National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania.
BMC Res Notes. 2018 Feb 9;11(1):121. doi: 10.1186/s13104-018-3235-7.
The gap between patients diagnosed with multi-drug resistant tuberculosis (MDR-TB) and enrolment in treatment is one of the major challenges in tuberculosis control programmes. A 4-year (2013-2016) retrospective review of patients' clinical data and subsequent in-depth interviews with health providers were conducted to assess the effectiveness of the GeneXpert GxAlert platform for MDR-TB diagnosis and its impact on linkage of patients to care in Tanzania.
A total of 782 new rifampicin resistant cases were notified, but only 242 (32.3%) were placed in an MDR-TB regimens. The remaining 540 (67.07%) patients were not on treatment, of which 103 patients had complete records on the GxAlert database. Of the 103 patients: 39 were judged as untraceable; 27 died before treatment; 12 were treated with first-line anti-TBs; 9 repeat tests did not show rifampicin resistance; 15 were not on treatment due to communication breakdown, and 1 patient was transferred outside the country. In-depth interviews with health providers suggested that the pre-treatment loss for the MDR-TB patients was primarily attributed to health system and patients themselves. We recommend strengthening the health system by developing and implementing well-defined interventions to ensure all diagnosed MDR-TB patients are accurately reported and timely linked to treatment.
确诊的耐多药结核病（MDR-TB）患者与开始治疗之间的差距是结核病控制项目的主要挑战之一。对患者的临床数据进行了为期4年（2013 - 2016年）的回顾性审查，并随后对医疗服务提供者进行了深入访谈，以评估GeneXpert GxAlert平台对坦桑尼亚耐多药结核病诊断的有效性及其对患者与医疗服务衔接的影响。
共报告了782例新的利福平耐药病例，但只有242例（32.3%）开始接受耐多药结核病治疗方案。其余540例（67.07%）患者未接受治疗，其中103例患者在GxAlert数据库中有完整记录。在这103例患者中：39例被判定为无法追踪；27例在治疗前死亡；12例接受一线抗结核治疗；9例重复检测未显示利福平耐药；15例因沟通中断未接受治疗，1例患者被转移到国外。对医疗服务提供者的深入访谈表明，耐多药结核病患者治疗前流失主要归因于卫生系统和患者自身。我们建议通过制定和实施明确的干预措施来加强卫生系统，以确保所有确诊的耐多药结核病患者得到准确报告并及时与治疗衔接。
