Jouego Christelle Geneviève, Decroo Tom, Netongo Palmer Masumbe, Gils Tinne
Molecular Diagnostics Research Group (MDRG), University of Yaoundé 1, Biotechnology Center, Nkolbisson, Cameroon
Unit of HIV and Tuberculosis, Institute of Tropical Medicine Department of Clinical Sciences, Antwerpen, Belgium.
BMJ Glob Health. 2025 Jan 22;10(1):e015977. doi: 10.1136/bmjgh-2024-015977.
The WHO endorsed the Xpert MTB/RIF (Xpert) technique since 2011 as initial test to diagnose rifampicin-resistant tuberculosis (RR-TB). No systematic review has quantified the proportion of pretreatment attrition in RR-TB patients diagnosed with Xpert in high TB burden countries.Pretreatment attrition for RR-TB represents the gap between patients diagnosed and those who effectively started anti-TB treatment regardless of the reasons (which include pretreatment mortality (death of a diagnosed RR-TB patient before starting adequate treatment) and/or pretreatment loss to follow-up (PTLFU) (drop-out of a diagnosed RR-TB patient before initiation of anti-TB treatment).
In this systematic review and meta-analysis, we queried EMBASE, PubMed and Web of science to retrieve studies published between 2011 and 22 July 2024, that described pretreatment attrition for RR-TB using Xpert in high TB burden countries. Data on RR-TB patients who did not start treatment after diagnosis and reasons for not starting were extracted in an Excel table. A modified version of the Newcastle-Ottawa scale was used to evaluate the risk of bias among all included studies. The pooled proportion of pretreatment attrition and reasons were assessed using random-effects meta-analysis. Forest plots were generated using R software.
Thirty eligible studies from 21 countries were identified after full-text screening and included in the meta-analysis. Most studies used routine programme data. The pooled proportion of pretreatment attrition in included studies was 18% (95% CI: 12 to 25). PTLFU and pretreatment mortality were, respectively, reported in 10 and nine studies and explained 78% (95% CI: 51% to 92%) and 30% (95% CI: 15% to 52%) of attrition.
Pretreatment attrition was widespread, with significant heterogeneity between included studies. National TB programmes should ensure accurate data collection and reporting of pretreatment attrition to enable reliable overall control strategies.
CRD42022321509.
自2011年以来，世界卫生组织认可了Xpert MTB/RIF（Xpert）技术作为诊断耐利福平结核病（RR-TB）的初始检测方法。尚无系统评价对高结核病负担国家中通过Xpert诊断出的RR-TB患者治疗前减员比例进行量化。RR-TB的治疗前减员是指诊断出的患者与实际开始抗结核治疗的患者之间的差距，无论原因如何（包括治疗前死亡（确诊的RR-TB患者在开始充分治疗前死亡）和/或治疗前失访（PTLFU）（确诊的RR-TB患者在开始抗结核治疗前退出））。
在这项系统评价和荟萃分析中，我们检索了EMBASE、PubMed和科学网，以获取2011年至2024年7月22日期间发表的研究，这些研究描述了高结核病负担国家中使用Xpert检测RR-TB的治疗前减员情况。将诊断后未开始治疗的RR-TB患者的数据以及未开始治疗的原因提取到Excel表格中。使用纽卡斯尔-渥太华量表的修改版评估所有纳入研究的偏倚风险。使用随机效应荟萃分析评估治疗前减员的合并比例及原因。使用R软件生成森林图。
经过全文筛选，确定了来自21个国家的30项符合条件的研究并纳入荟萃分析。大多数研究使用常规项目数据。纳入研究中治疗前减员的合并比例为18%（95%CI：12%至25%）。分别有10项和9项研究报告了PTLFU和治疗前死亡情况，它们分别解释了78%（95%CI：51%至92%）和30%（95%CI：15%至52%）的减员情况。
治疗前减员情况普遍存在，纳入研究之间存在显著异质性。国家结核病规划应确保准确收集和报告治疗前减员数据，以制定可靠的总体控制策略。
PROSPERO注册号：CRD42022321509。
