Xpert MTB/RIF 检测和 GxAlert 对莫桑比克耐多药结核病诊断和治疗关联的影响。
Effects of Xpert MTB/RIF testing and GxAlert on MDR-TB diagnosis and linkage to care in Mozambique.
机构信息
Health Alliance International, Seattle, Washington, Division of Allergy and Infectious Disease, University of Washington, Seattle, Washington, USA.
Health Alliance International, Seattle, Washington, Mozambican National Tuberculosis Control Programme, Maputo, Mozambique.
出版信息
Int J Tuberc Lung Dis. 2018 Nov 1;22(11):1358-1365. doi: 10.5588/ijtld.17.0901.
SETTING
The diagnosis of multidrug-resistant tuberculosis (MDR-TB) and gaps in linkage to care are the principal health challenges in Mozambique. Five GeneXpert machines and GxAlert, an eHealth platform, were installed in Sofala and Manica Provinces between 2012 and 2014.
OBJECTIVE
To test the effects of Xpert MTB/RIF testing and GxAlert on rifampin-resistant TB (RR-TB) diagnosis and second-line treatment initiation rates.
DESIGN
We conducted a retrospective clinical review of patients with RR-TB from March 2012 to September 2015 at these five sites. Time-series analyses were conducted to investigate the impact of Xpert on case detection and treatment. Pre- and post- analyses were conducted to investigate the impact of GxAlert.
RESULTS
A total of 32 182 Xpert tests were conducted: 4010 (12.5%) detected TB without rifampin resistance, and 306 (7.1%) had RR-TB. Of the RR-TB cases, 161 (52.6%) were started on MDR-TB treatment, 6.9% had documented culture results, and time from diagnosis to treatment initiation decreased over time. The absolute number of patients diagnosed and started on MDR-TB treatment increased by 0.26 (95%CI 0.15-0.38, < 0.001) and 0.16 (95%CI 0.089-0.24, 0.001) every 6 months. GxAlert did not affect treatment initiation rates.
CONCLUSION
Implementation of Xpert testing was associated with increases in the number of patients diagnosed and started on MDR-TB treatment.
背景
耐多药结核病（MDR-TB）的诊断和治疗衔接方面的差距是莫桑比克的主要卫生挑战。2012 年至 2014 年间，在索法拉省和马尼卡省安装了五台 GeneXpert 机器和 GxAlert 电子健康平台。
目的
检测 Xpert MTB/RIF 检测和 GxAlert 对利福平耐药结核病（RR-TB）诊断和二线治疗启动率的影响。
设计
我们对这五个地点 2012 年 3 月至 2015 年 9 月期间 RR-TB 患者进行了回顾性临床审查。进行时间序列分析以调查 Xpert 对病例检出和治疗的影响。进行了预分析和后分析以调查 GxAlert 的影响。
结果
共进行了 32182 次 Xpert 检测：4010 次（12.5%）检测出无利福平耐药的结核病，306 次（7.1%）检测出 RR-TB。在 RR-TB 病例中，161 例（52.6%）开始接受 MDR-TB 治疗，6.9%有记录的培养结果，且从诊断到治疗开始的时间随时间推移而缩短。诊断和开始接受 MDR-TB 治疗的患者绝对数量每增加 6 个月分别增加 0.26（95%CI 0.15-0.38，<0.001）和 0.16（95%CI 0.089-0.24，0.001）。GxAlert 并未影响治疗启动率。
结论
实施 Xpert 检测与诊断和开始接受 MDR-TB 治疗的患者数量增加有关。
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