Banamu J K, Lavu E, Johnson K, Moke R, Majumdar S S, Takarinda K C, Commons R J
Central Public Health Laboratory, Port Moresby, Papua New Guinea (PNG).
Health and HIV Implementation Services Provider, Port Morseby, PNG.
Public Health Action. 2019 Sep 21;9(Suppl 1):S19-S24. doi: 10.5588/pha.18.0067.
GxAlert is an automatic electronic notification service that provides immediate Xpert MTB/RIF testing results. It was implemented for the notification of patients with rifampicin resistant-tuberculosis (RR-TB) at Port Moresby General Hospital, Port Moresby, Papua New Guinea, in May 2015.
To determine if there were differences in pre-treatment attrition, the time to treatment initiation and patient outcomes in the 12 months pre- and post-introduction of GxAlert for RR-TB patients.
This was a retrospective cohort study.
The median time from Xpert testing to treatment initiation decreased from 35 days [IQR 13-131] prior to GxAlert to 10 days [IQR 3-29] after GxAlert ( = 0.001), with the cumulative proportion of patients initiating treatment within 30 days increasing from 25% (95%CI 17-37) to 54% (95%CI 44-64; < 0.001) over these periods. However, our analysis of the time to treatment prior to the introduction of GxAlert suggests that a decrease had already occurred prior to implementation. There was no difference in interim clinical outcomes between the periods.
Although a decrease in time to treatment initiation cannot be attributed to GxAlert, there was a significant improvement over the 2-year period, suggesting that considerable improvements have been made in timely RR-TB patient management in Port Moresby.
GxAlert是一项自动电子通知服务，可提供即时的Xpert MTB/RIF检测结果。2015年5月，该服务在巴布亚新几内亚莫尔斯比港的莫尔斯比港总医院实施，用于通知耐利福平结核病（RR-TB）患者。
确定在引入GxAlert前后12个月内，RR-TB患者的治疗前流失率、开始治疗的时间和患者预后是否存在差异。
这是一项回顾性队列研究。
从Xpert检测到开始治疗的中位时间从GxAlert引入前的35天[四分位间距13 - 131]降至引入后的10天[四分位间距3 - 29]（P = 0.001），在此期间，30天内开始治疗的患者累积比例从25%（95%置信区间17 - 37）增至54%（95%置信区间44 - 64；P < 0.001）。然而，我们对引入GxAlert之前治疗时间的分析表明，在实施之前就已经出现了下降。两个时期的中期临床结果没有差异。
虽然开始治疗时间的缩短不能归因于GxAlert，但在两年期间有显著改善，这表明莫尔斯比港在RR-TB患者的及时管理方面取得了相当大的进步。
