Limits...
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.

Show MeSH

Related in: MedlinePlus

Two and six-month outcomes of 591Xpert-negative TB suspects and 50 Xpert-positive TB suspects presenting to a primary care clinic in Johannesburg, South Africa.Abbreviations: LTFU, lost to follow-up; TB, tuberculosis; mo, month; Rx, treatment.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3675091&req=5

pone-0065421-g003: Two and six-month outcomes of 591Xpert-negative TB suspects and 50 Xpert-positive TB suspects presenting to a primary care clinic in Johannesburg, South Africa.Abbreviations: LTFU, lost to follow-up; TB, tuberculosis; mo, month; Rx, treatment.

Mentions: Among TB suspects with a negative initial Xpert, 18% had persistent TB symptoms at two months of follow-up, but only 3% remained symptomatic at six months (see Figure 3). The prevalence of persistent symptoms was similar between possible and confirmed TB cases, with 14% of possible and 18% of confirmed cases having symptoms at two months (p = 0.121), and 1% of possible and 0% of confirmed TB cases having TB symptoms at six months follow-up (p = 0.072). TB treatment outcomes between Xpert-positive and negative TB cases were not different (p 0.460). Among the 48 Xpert-positive cases started on treatment, 48% had a successful treatment outcome (six month treatment completion or cure), 25% transferred out, 23% defaulted, 2% were still on treatment and 2% died. Among the 58 Xpert-negative patients started on treatment, 64% completed or cured, 19% transferred, 12% defaulted, 3% still on treatment, and 2% died. Among TB suspects classified as not having TB, 1% died (3/535). TB treatment outcomes were also similar between confirmed and possible TB cases (p = 0.262).


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)

Two and six-month outcomes of 591Xpert-negative TB suspects and 50 Xpert-positive TB suspects presenting to a primary care clinic in Johannesburg, South Africa.Abbreviations: LTFU, lost to follow-up; TB, tuberculosis; mo, month; Rx, treatment.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0065421-g003: Two and six-month outcomes of 591Xpert-negative TB suspects and 50 Xpert-positive TB suspects presenting to a primary care clinic in Johannesburg, South Africa.Abbreviations: LTFU, lost to follow-up; TB, tuberculosis; mo, month; Rx, treatment.
Mentions: Among TB suspects with a negative initial Xpert, 18% had persistent TB symptoms at two months of follow-up, but only 3% remained symptomatic at six months (see Figure 3). The prevalence of persistent symptoms was similar between possible and confirmed TB cases, with 14% of possible and 18% of confirmed cases having symptoms at two months (p = 0.121), and 1% of possible and 0% of confirmed TB cases having TB symptoms at six months follow-up (p = 0.072). TB treatment outcomes between Xpert-positive and negative TB cases were not different (p 0.460). Among the 48 Xpert-positive cases started on treatment, 48% had a successful treatment outcome (six month treatment completion or cure), 25% transferred out, 23% defaulted, 2% were still on treatment and 2% died. Among the 58 Xpert-negative patients started on treatment, 64% completed or cured, 19% transferred, 12% defaulted, 3% still on treatment, and 2% died. Among TB suspects classified as not having TB, 1% died (3/535). TB treatment outcomes were also similar between confirmed and possible TB cases (p = 0.262).

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