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Time to treatment and patient outcomes among TB suspects screened by a single point-of-care xpert MTB/RIF at a primary care clinic in Johannesburg, South Africa.

Hanrahan CF, Selibas K, Deery CB, Dansey H, Clouse K, Bassett J, Scott L, Stevens W, Sanne I, Van Rie A - PLoS ONE (2013)

Bottom Line: Few data are available on the impact of this recommendation on patient outcomes.In a high HIV-burden setting, a single Xpert identified less than half of those started on tuberculosis treatment, highlighting the complexity of TB diagnosis even in the Xpert era.Xpert at point-of-care resulted in same day treatment initiation in Xpert-positives, but had no impact on tuberculosis treatment outcomes or mortality.

View Article: PubMed Central - PubMed

Affiliation: University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America. colleen_hanrahan@unc.edu

ABSTRACT

Introduction: In December 2010, the World Health Organization recommended a single Xpert MTB/RIF assay as the initial diagnostic in people suspected of HIV-associated or drug resistant tuberculosis. Few data are available on the impact of this recommendation on patient outcomes. We describe the diagnostic follow-up, clinical characteristics and outcomes of a cohort of tuberculosis suspects screened using a single point-of-care Xpert.

Methods: Consecutive tuberculosis suspects at a primary care clinic in Johannesburg, South Africa were assessed for tuberculosis using point-of-care Xpert. Sputum smear microscopy and liquid culture were performed as reference standards. Xpert-negatives were evaluated clinically, and further assessed at the discretion of clinicians. Participants were followed for six months.

Results: From July-September 2011, 641 tuberculosis suspects were enrolled, of whom 69% were HIV-infected. Eight percent were positive by a single Xpert. Among 116 individuals diagnosed with TB, 66 (57%) were Xpert negative, of which 44 (67%) were empirical or radiological diagnoses and 22 (33%) were Xpert negative/culture-positive. The median time to tuberculosis treatment was 0 days (IQR: 0-0) for Xpert positives, 14 days (IQR: 5-35) for those diagnosed empirically, 14 days (IQR: 7-29) for radiological diagnoses, and 144 days (IQR: 28-180) for culture positives. Xpert negative tuberculosis cases were clinically similar to Xpert positives, including HIV status and CD4 count, and had similar treatment outcomes including mortality and time to antiretroviral treatment initiation.

Conclusions: In a high HIV-burden setting, a single Xpert identified less than half of those started on tuberculosis treatment, highlighting the complexity of TB diagnosis even in the Xpert era. Xpert at point-of-care resulted in same day treatment initiation in Xpert-positives, but had no impact on tuberculosis treatment outcomes or mortality.

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Time to TB treatment in 114 TB cases, by basis of TB treatment initiation.Kaplan-Meier curves showing time to treatment stratified by basis of TB diagnosis, excluding those diagnosed based on 2nd Xpert or sputum smear microscopy (n = 2). The median time to treatment and IQR for each basis of TB treatment initiation are listed. Abbreviation: TB, tuberculosis.
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pone-0065421-g002: Time to TB treatment in 114 TB cases, by basis of TB treatment initiation.Kaplan-Meier curves showing time to treatment stratified by basis of TB diagnosis, excluding those diagnosed based on 2nd Xpert or sputum smear microscopy (n = 2). The median time to treatment and IQR for each basis of TB treatment initiation are listed. Abbreviation: TB, tuberculosis.

Mentions: In total, 106 of the 116 TB caseswere started on TB treatment by six months following the initial Xpert assay. Almost all (48/50, 96%) Xpert positive patients started treatment, 2 were lost to follow-up., The proportion of Xpert-negative TB cases starting TB treatment was 70% (14/20) of culture positives, 95% (18/19) of individuals with suggestive chest x-ray, 100% (1/1) with positive 2nd Xpert, and 0% (0/1) with positive smear microscopy. In addition, 25 individuals started empiric TB treatment. The median time to TB treatment was 0 days (IQR: 0–0) for those positive on the initial Xpert, 14 days (IQR: 5–35) for empiric TB, 14 days (IQR: 7–29) for those starting treatment based on suggestive chest x-ray findings, and 144 days (IQR: 28–180) for culture positive, Xpert-negative patients (see Figure 2).


Time to treatment and patient outcomes among TB suspects screened by a single point-of-care xpert MTB/RIF at a primary care clinic in Johannesburg, South Africa.

Hanrahan CF, Selibas K, Deery CB, Dansey H, Clouse K, Bassett J, Scott L, Stevens W, Sanne I, Van Rie A - PLoS ONE (2013)

Time to TB treatment in 114 TB cases, by basis of TB treatment initiation.Kaplan-Meier curves showing time to treatment stratified by basis of TB diagnosis, excluding those diagnosed based on 2nd Xpert or sputum smear microscopy (n = 2). The median time to treatment and IQR for each basis of TB treatment initiation are listed. Abbreviation: TB, tuberculosis.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3675091&req=5

pone-0065421-g002: Time to TB treatment in 114 TB cases, by basis of TB treatment initiation.Kaplan-Meier curves showing time to treatment stratified by basis of TB diagnosis, excluding those diagnosed based on 2nd Xpert or sputum smear microscopy (n = 2). The median time to treatment and IQR for each basis of TB treatment initiation are listed. Abbreviation: TB, tuberculosis.
Mentions: In total, 106 of the 116 TB caseswere started on TB treatment by six months following the initial Xpert assay. Almost all (48/50, 96%) Xpert positive patients started treatment, 2 were lost to follow-up., The proportion of Xpert-negative TB cases starting TB treatment was 70% (14/20) of culture positives, 95% (18/19) of individuals with suggestive chest x-ray, 100% (1/1) with positive 2nd Xpert, and 0% (0/1) with positive smear microscopy. In addition, 25 individuals started empiric TB treatment. The median time to TB treatment was 0 days (IQR: 0–0) for those positive on the initial Xpert, 14 days (IQR: 5–35) for empiric TB, 14 days (IQR: 7–29) for those starting treatment based on suggestive chest x-ray findings, and 144 days (IQR: 28–180) for culture positive, Xpert-negative patients (see Figure 2).

Bottom Line: Few data are available on the impact of this recommendation on patient outcomes.In a high HIV-burden setting, a single Xpert identified less than half of those started on tuberculosis treatment, highlighting the complexity of TB diagnosis even in the Xpert era.Xpert at point-of-care resulted in same day treatment initiation in Xpert-positives, but had no impact on tuberculosis treatment outcomes or mortality.

View Article: PubMed Central - PubMed

Affiliation: University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America. colleen_hanrahan@unc.edu

ABSTRACT

Introduction: In December 2010, the World Health Organization recommended a single Xpert MTB/RIF assay as the initial diagnostic in people suspected of HIV-associated or drug resistant tuberculosis. Few data are available on the impact of this recommendation on patient outcomes. We describe the diagnostic follow-up, clinical characteristics and outcomes of a cohort of tuberculosis suspects screened using a single point-of-care Xpert.

Methods: Consecutive tuberculosis suspects at a primary care clinic in Johannesburg, South Africa were assessed for tuberculosis using point-of-care Xpert. Sputum smear microscopy and liquid culture were performed as reference standards. Xpert-negatives were evaluated clinically, and further assessed at the discretion of clinicians. Participants were followed for six months.

Results: From July-September 2011, 641 tuberculosis suspects were enrolled, of whom 69% were HIV-infected. Eight percent were positive by a single Xpert. Among 116 individuals diagnosed with TB, 66 (57%) were Xpert negative, of which 44 (67%) were empirical or radiological diagnoses and 22 (33%) were Xpert negative/culture-positive. The median time to tuberculosis treatment was 0 days (IQR: 0-0) for Xpert positives, 14 days (IQR: 5-35) for those diagnosed empirically, 14 days (IQR: 7-29) for radiological diagnoses, and 144 days (IQR: 28-180) for culture positives. Xpert negative tuberculosis cases were clinically similar to Xpert positives, including HIV status and CD4 count, and had similar treatment outcomes including mortality and time to antiretroviral treatment initiation.

Conclusions: In a high HIV-burden setting, a single Xpert identified less than half of those started on tuberculosis treatment, highlighting the complexity of TB diagnosis even in the Xpert era. Xpert at point-of-care resulted in same day treatment initiation in Xpert-positives, but had no impact on tuberculosis treatment outcomes or mortality.

Show MeSH
Related in: MedlinePlus