Xpert MTB/RIF Associated with Improved Treatment Initiation Among Patients with Smear-negative Tuberculosis

Overview

Journal Int J Tuberc Lung Dis

Specialty Pulmonary Medicine

Date 2019 Jan 5

PMID 30606320

Citations 9

Authors

S Zawedde-Muyanja

Y C Manabe

N K Sewankambo

L Nakiyingi

D Nakanjako

Affiliations

Soon will be listed here.

Abstract

Background: Delayed diagnosis and treatment initiation of smear-negative tuberculosis (TB) patients can lead to increased morbidity and mortality, particularly among those co-infected with the human immunodeficiency virus (HIV).

Objective: To compare TB treatment initiation among smear-negative presumptive TB patients in the 6 months before and after the introduction of Xpert MTB/RIF testing at five rural tertiary hospitals in Uganda.

Methods: Patient records of the dates and results of sputum analysis were extracted from TB laboratory registers and linked to those on treatment initiation as indicated in the TB treatment registers. The proportion of smear-negative presumptive patients who initiated anti-tuberculosis treatment was compared before and after Xpert implementation using χ² tests. Time to treatment was analysed using Kaplan-Meier survival analysis.

Results: Records from 3658 patients were analysed, 1894 before and 1764 after the introduction of Xpert testing. After the introduction of Xpert, 25% (437/1764) of smear-negative presumptive TB patients underwent testing. The proportion initiated on anti-tuberculosis treatment increased from 5.9% (112/1894) to 10.8% (190/1764) ( < 0.01). However, 37% (32/87) of patients with a confirmed TB diagnosis did not initiate treatment. Time to TB treatment initiation improved from 8 to 3.5 days between the study periods.

Conclusion: Xpert testing was associated with improved TB treatment initiation among smear-negative presumptive TB patients. Improved utilisation and linkage to treatment could improve the impact of this test on patient-centred outcomes.

Citing Articles

Patient and health system level barriers to and facilitators for tuberculosis treatment initiation in Uganda: a qualitative study.

Zawedde-Muyanja S, Manabe Y, Cattamanchi A, Castelnuovo B, Katamba A BMC Health Serv Res. 2022; 22(1):831.

PMID: 35764982 PMC: 9513807. DOI: 10.1186/s12913-022-08213-w.

Feasibility of a multifaceted intervention to improve treatment initiation among patients diagnosed with TB using Xpert MTB/RIF testing in Uganda.

Zawedde-Muyanja S, Musaazi J, Castelnuovo B, Cattamanchi A, Katamba A, Manabe Y PLoS One. 2022; 17(6):e0265035.

PMID: 35714072 PMC: 9491700. DOI: 10.1371/journal.pone.0265035.

Comparative yield of different active TB case finding interventions in a large urban TB project in central Uganda: a descriptive study.

Kazibwe A, Twinomugisha F, Musaazi J, Nakaggwa F, Lukanga D, Aleu P Afr Health Sci. 2022; 21(3):975-984.

PMID: 35222557 PMC: 8843286. DOI: 10.4314/ahs.v21i3.3.

Bronchial brushing Xpert improves the diagnostic efficiency of sputum Xpert in patients with pulmonary tuberculosis.

He Y, Wu Y, Han C, Gong H, Wang M Ther Adv Infect Dis. 2021; 8:20499361211020174.

PMID: 34164125 PMC: 8188970. DOI: 10.1177/20499361211020174.

Combined tests with Xpert MTB/RIF assay with bronchoalveolar lavage fluid increasing the diagnostic performance of smear-negative pulmonary tuberculosis in Eastern China.

Liu Q, Ji Y, Martinez L, Lu W, Shi X, Wang J Epidemiol Infect. 2021; 149:e5.

PMID: 33436140 PMC: 8057514. DOI: 10.1017/S095026882000309X.

References

Manabe Y, Zawedde-Muyanja S, Burnett S, Mugabe F, Naikoba S, Coutinho A . Rapid improvement in passive tuberculosis case detection and tuberculosis treatment outcomes after implementation of a bundled laboratory diagnostic and on-site training intervention targeting mid-level providers. Open Forum Infect Dis. 2015; 2(1):ofv030. PMC: 4438908. DOI: 10.1093/ofid/ofv030. View

Getahun H, Harrington M, OBrien R, Nunn P . Diagnosis of smear-negative pulmonary tuberculosis in people with HIV infection or AIDS in resource-constrained settings: informing urgent policy changes. Lancet. 2007; 369(9578):2042-2049. DOI: 10.1016/S0140-6736(07)60284-0. View

Kiyaga C, Sendagire H, Joseph E, McConnell I, Grosz J, Narayan V . Uganda's new national laboratory sample transport system: a successful model for improving access to diagnostic services for Early Infant HIV Diagnosis and other programs. PLoS One. 2013; 8(11):e78609. PMC: 3827263. DOI: 10.1371/journal.pone.0078609. View

Abdurrahman S, Emenyonu N, Obasanya O, Lawson L, Dacombe R, Muhammad M . The hidden costs of installing Xpert machines in a tuberculosis high-burden country: experiences from Nigeria. Pan Afr Med J. 2014; 18:277. PMC: 4258200. DOI: 10.11604/pamj.2014.18.277.3906. View

Sekandi J, Zalwango S, Martinez L, Handel A, Kakaire R, Nkwata A . Four Degrees of Separation: Social Contacts and Health Providers Influence the Steps to Final Diagnosis of Active Tuberculosis Patients in Urban Uganda. BMC Infect Dis. 2015; 15:361. PMC: 4546132. DOI: 10.1186/s12879-015-1084-8. View

Cox H, Mbhele S, Mohess N, Whitelaw A, Muller O, Zemanay W . Impact of Xpert MTB/RIF for TB diagnosis in a primary care clinic with high TB and HIV prevalence in South Africa: a pragmatic randomised trial. PLoS Med. 2014; 11(11):e1001760. PMC: 4244039. DOI: 10.1371/journal.pmed.1001760. View

Hanrahan C, Haguma P, Ochom E, Kinera I, Cobelens F, Cattamanchi A . Implementation of Xpert MTB/RIF in Uganda: Missed Opportunities to Improve Diagnosis of Tuberculosis. Open Forum Infect Dis. 2016; 3(2):ofw068. PMC: 4866550. DOI: 10.1093/ofid/ofw068. View

Shrestha P, Arjyal A, Caws M, Govinda Prajapati K, Karkey A, Dongol S . The Application of GeneXpert MTB/RIF for Smear-Negative TB Diagnosis as a Fee-Paying Service at a South Asian General Hospital. Tuberc Res Treat. 2015; 2015:102430. PMC: 4407628. DOI: 10.1155/2015/102430. View

Durovni B, Saraceni V, van den Hof S, Trajman A, Cordeiro-Santos M, Cavalcante S . Impact of replacing smear microscopy with Xpert MTB/RIF for diagnosing tuberculosis in Brazil: a stepped-wedge cluster-randomized trial. PLoS Med. 2014; 11(12):e1001766. PMC: 4260794. DOI: 10.1371/journal.pmed.1001766. View

10.

van Lettow M, Bedell R, Maosa S, Phiri K, Chan A, Mwinjiwa E . Outcomes and Diagnostic Processes in Outpatients with Presumptive Tuberculosis in Zomba District, Malawi. PLoS One. 2015; 10(11):e0141414. PMC: 4640882. DOI: 10.1371/journal.pone.0141414. View

11.

Horton K, MacPherson P, Houben R, White R, Corbett E . Sex Differences in Tuberculosis Burden and Notifications in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis. PLoS Med. 2016; 13(9):e1002119. PMC: 5012571. DOI: 10.1371/journal.pmed.1002119. View

12.

Cowan J, Michel C, Manhica I, Monivo C, Saize D, Creswell J . Implementing rapid testing for tuberculosis in Mozambique. Bull World Health Organ. 2015; 93(2):125-30. PMC: 4339961. DOI: 10.2471/BLT.14.138560. View

13.

Negin J, Abimbola S, Marais B . Tuberculosis among older adults--time to take notice. Int J Infect Dis. 2015; 32:135-7. DOI: 10.1016/j.ijid.2014.11.018. View

14.

Harries A, Hargreaves N, Kemp J, Jindani A, Enarson D, Maher D . Deaths from tuberculosis in sub-Saharan African countries with a high prevalence of HIV-1. Lancet. 2001; 357(9267):1519-23. DOI: 10.1016/S0140-6736(00)04639-0. View

15.

Nakiyingi L, Bwanika J, Kirenga B, Nakanjako D, Katabira C, Lubega G . Clinical predictors and accuracy of empiric tuberculosis treatment among sputum smear-negative HIV-infected adult TB suspects in Uganda. PLoS One. 2013; 8(9):e74023. PMC: 3765314. DOI: 10.1371/journal.pone.0074023. View

16.

Boehme C, Nabeta P, Hillemann D, Nicol M, Shenai S, Krapp F . Rapid molecular detection of tuberculosis and rifampin resistance. N Engl J Med. 2010; 363(11):1005-15. PMC: 2947799. DOI: 10.1056/NEJMoa0907847. View

17.

Sikhondze W, Dlamini T, Khumalo D, Maphalala G, Dlamini S, Zikalala T . Countrywide roll-out of Xpert(®) MTB/RIF in Swaziland: the first three years of implementation. Public Health Action. 2015; 5(2):140-6. PMC: 4487476. DOI: 10.5588/pha.15.0001. View

18.

Lawn S, Kerkhoff A, Wood R . Location of Xpert® MTB/RIF in centralised laboratories in South Africa undermines potential impact. Int J Tuberc Lung Dis. 2012; 16(5):701. DOI: 10.5588/ijtld.12.0131. View

19.

Corbett E, Watt C, Walker N, Maher D, Williams B, Raviglione M . The growing burden of tuberculosis: global trends and interactions with the HIV epidemic. Arch Intern Med. 2003; 163(9):1009-21. DOI: 10.1001/archinte.163.9.1009. View

20.

Yoon C, Cattamanchi A, Davis J, Worodria W, den Boon S, Kalema N . Impact of Xpert MTB/RIF testing on tuberculosis management and outcomes in hospitalized patients in Uganda. PLoS One. 2012; 7(11):e48599. PMC: 3490868. DOI: 10.1371/journal.pone.0048599. View