Delays and loss to follow-up before treatment of drug-resistant tuberculosis following implementation of Xpert MTB/RIF in South Africa: A retrospective cohort study
South Africa has a large burden of rifampicin-resistant tuberculosis (RR-TB), with 18,734 patients diagnosed in 2014. The number of diagnosed patients has increased substantially with the introduction of the Xpert MTB/RIF test, used for tuberculosis (TB) diagnosis for all patients with presumptive T...
Gespeichert in:
| Veröffentlicht in: | PLoS medicine 2017-02, Vol.14 (2), p.e1002238-e1002238 |
|---|---|
| Hauptverfasser: | , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | e1002238 |
|---|---|
| container_issue | 2 |
| container_start_page | e1002238 |
| container_title | PLoS medicine |
| container_volume | 14 |
| creator | Cox, Helen Dickson-Hall, Lindy Ndjeka, Norbert Van't Hoog, Anja Grant, Alison Cobelens, Frank Stevens, Wendy Nicol, Mark |
| description | South Africa has a large burden of rifampicin-resistant tuberculosis (RR-TB), with 18,734 patients diagnosed in 2014. The number of diagnosed patients has increased substantially with the introduction of the Xpert MTB/RIF test, used for tuberculosis (TB) diagnosis for all patients with presumptive TB. Routine aggregate data suggest a large treatment gap (pre-treatment loss to follow-up) between the numbers of patients with laboratory-confirmed RR-TB and those reported to have started second-line treatment. We aimed to assess the impact of Xpert MTB/RIF implementation on the delay to treatment initiation and loss to follow-up before second-line treatment for RR-TB across South Africa.
A nationwide retrospective cohort study was conducted to assess second-line treatment initiation and treatment delay among laboratory-diagnosed RR-TB patients. Cohorts, including approximately 300 sequentially diagnosed RR-TB patients per South African province, were drawn from the years 2011 and 2013, i.e., before and after Xpert implementation. Patients with prior laboratory RR-TB diagnoses within 6 mo and currently treated patients were excluded. Treatment initiation was determined through data linkage with national and local treatment registers, medical record review, interviews with health care staff, and direct contact with patients or household members. Additional laboratory data were used to track cases. National estimates of the percentage of patients who initiated treatment and time to treatment were weighted to account for the sampling design. There were 2,508 and 2,528 eligible patients in the 2011 and 2013 cohorts, respectively; 92% were newly diagnosed with RR-TB (no prior RR-TB diagnoses). Nationally, among the 2,340 and 2,311 new RR-TB patients in the 2011 and 2013 cohorts, 55% (95% CI 53%-57%) and 63% (95% CI 61%-65%), respectively, started treatment within 6 mo of laboratory receipt of their diagnostic specimen (p < 0.001). However, in 2013, there was no difference in the percentage of patients who initiated treatment at 6 mo between the 1,368 new RR-TB patients diagnosed by Xpert (62%, 95% CI 59%-65%) and the 943 diagnosed by other methods (64%, 95% CI 61%-67%) (p = 0.39). The median time to treatment decreased from 44 d (interquartile range [IQR] 20-69) in 2011 to 22 d (IQR 2-43) in 2013 (p < 0.001). In 2013, across the nine provinces, there were substantial variations in both treatment initiation (range 51%-73% by 6 mo) and median time to treatment (range |
| doi_str_mv | 10.1371/journal.pmed.1002238 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_plos_</sourceid><recordid>TN_cdi_plos_journals_1878071797</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A493761569</galeid><doaj_id>oai_doaj_org_article_483833597afc468ba1a1a144cf5a5f55</doaj_id><sourcerecordid>A493761569</sourcerecordid><originalsourceid>FETCH-LOGICAL-c764t-643caf2965f88d45ad79019856643e91c05db0abfd293b3a032021b43763d5f93</originalsourceid><addsrcrecordid>eNqVk8Fu1DAQhiMEoqXwBggsISE4ZGvHcRJzQFoKhZUKldqCuFmOY2ddeeNgO4W-Dw-K002rXbQHkA-Jxt__2zPjSZKnCM4QLtHhpR1cx82sX8lmhiDMMlzdS_YRyWmKirK4v_G_lzzy_jIyFFL4MNnLqizLICX7ye_30vBrD3jXAGO9B8ECZY2xP9OhB7VU1kkQnORhJbsArAKNG9rUSa994DEShlo6MUSt9pNSdy3Qq97IUcKDtt2o-95LF8Dni3eHZ4tjoDtwboewBHPltOBvwBw4GZz1vRRBX0kg7NJG3oehuX6cPFDcePlk-h4kX48_XBx9Sk9OPy6O5iepKIs8pEWOBVcZLYiqqiYnvCkpRLQiRdyRFAlImhryWjUZxTXmEGcwQ3WOywI3RFF8kDxf-_YxHTYV2DNUlRUsUUnLSCzWRGP5JeudXnF3zSzX7CZgXcu4C1oYyfIKVxgTWnIl8qKqORpXngtFOFGERK-302lDHXsoYrEcN1um2zudXrLWXjGCES3y0eDVZODsj0H6wFbaC2kM76Qdbu4NaVWUVR7RF3-hu7ObqJbHBHSnbDxXjKZsntNYJkSKsUrpDqqVnYyXtJ1UOoa3-NkOPq5GrrTYKXi9JYhMkL9Cywfv2eL87D_YL__Onn7bZl9usEvJTVh6a4bxNfttMF-DIj5e76S6ayCCbBzU20qzcVDZNKhR9myz-Xei28nEfwB_kzkI</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1878071797</pqid></control><display><type>article</type><title>Delays and loss to follow-up before treatment of drug-resistant tuberculosis following implementation of Xpert MTB/RIF in South Africa: A retrospective cohort study</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Public Library of Science (PLoS)</source><source>PubMed Central</source><creator>Cox, Helen ; Dickson-Hall, Lindy ; Ndjeka, Norbert ; Van't Hoog, Anja ; Grant, Alison ; Cobelens, Frank ; Stevens, Wendy ; Nicol, Mark</creator><contributor>Suthar, Amitabh Bipin</contributor><creatorcontrib>Cox, Helen ; Dickson-Hall, Lindy ; Ndjeka, Norbert ; Van't Hoog, Anja ; Grant, Alison ; Cobelens, Frank ; Stevens, Wendy ; Nicol, Mark ; Suthar, Amitabh Bipin</creatorcontrib><description>South Africa has a large burden of rifampicin-resistant tuberculosis (RR-TB), with 18,734 patients diagnosed in 2014. The number of diagnosed patients has increased substantially with the introduction of the Xpert MTB/RIF test, used for tuberculosis (TB) diagnosis for all patients with presumptive TB. Routine aggregate data suggest a large treatment gap (pre-treatment loss to follow-up) between the numbers of patients with laboratory-confirmed RR-TB and those reported to have started second-line treatment. We aimed to assess the impact of Xpert MTB/RIF implementation on the delay to treatment initiation and loss to follow-up before second-line treatment for RR-TB across South Africa.
A nationwide retrospective cohort study was conducted to assess second-line treatment initiation and treatment delay among laboratory-diagnosed RR-TB patients. Cohorts, including approximately 300 sequentially diagnosed RR-TB patients per South African province, were drawn from the years 2011 and 2013, i.e., before and after Xpert implementation. Patients with prior laboratory RR-TB diagnoses within 6 mo and currently treated patients were excluded. Treatment initiation was determined through data linkage with national and local treatment registers, medical record review, interviews with health care staff, and direct contact with patients or household members. Additional laboratory data were used to track cases. National estimates of the percentage of patients who initiated treatment and time to treatment were weighted to account for the sampling design. There were 2,508 and 2,528 eligible patients in the 2011 and 2013 cohorts, respectively; 92% were newly diagnosed with RR-TB (no prior RR-TB diagnoses). Nationally, among the 2,340 and 2,311 new RR-TB patients in the 2011 and 2013 cohorts, 55% (95% CI 53%-57%) and 63% (95% CI 61%-65%), respectively, started treatment within 6 mo of laboratory receipt of their diagnostic specimen (p < 0.001). However, in 2013, there was no difference in the percentage of patients who initiated treatment at 6 mo between the 1,368 new RR-TB patients diagnosed by Xpert (62%, 95% CI 59%-65%) and the 943 diagnosed by other methods (64%, 95% CI 61%-67%) (p = 0.39). The median time to treatment decreased from 44 d (interquartile range [IQR] 20-69) in 2011 to 22 d (IQR 2-43) in 2013 (p < 0.001). In 2013, across the nine provinces, there were substantial variations in both treatment initiation (range 51%-73% by 6 mo) and median time to treatment (range 15-36 d, n = 1,450), and only 53% of the 1,448 new RR-TB patients who received treatment were recorded in the national RR-TB register. This retrospective study is limited by the lack of information to assess reasons for non-initiation of treatment, particularly pre-treatment mortality data. Other limitations include the use of names and dates of birth to locate patient-level data, potentially resulting in missed treatment initiation among some patients.
In 2013, there was a large treatment gap for RR-TB in South Africa that varied significantly across provinces. Xpert implementation, while reducing treatment delay, had not contributed substantially to reducing the treatment gap in 2013. However, given improved case detection with Xpert, a larger proportion of RR-TB patients overall have received treatment, with reduced delays. Nonetheless, strategies to further improve linkage to treatment for all diagnosed RR-TB patients are urgently required.</description><identifier>ISSN: 1549-1676</identifier><identifier>ISSN: 1549-1277</identifier><identifier>EISSN: 1549-1676</identifier><identifier>DOI: 10.1371/journal.pmed.1002238</identifier><identifier>PMID: 28222095</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Analysis ; Antibiotics, Antitubercular - therapeutic use ; Clinical Protocols ; Cohort Studies ; Diagnosis ; Drug resistance ; Drug Resistance, Bacterial ; Drug therapy ; Female ; Global health ; Health services administration ; Humans ; Infectious diseases ; Laboratories ; Male ; Medicine and Health Sciences ; Microbial drug resistance ; Middle Aged ; Pathology ; Patients ; People and places ; Physiological aspects ; Public health ; Research and Analysis Methods ; Retrospective Studies ; South Africa ; Studies ; Tuberculosis ; Tuberculosis, Multidrug-Resistant - drug therapy</subject><ispartof>PLoS medicine, 2017-02, Vol.14 (2), p.e1002238-e1002238</ispartof><rights>COPYRIGHT 2017 Public Library of Science</rights><rights>2017 Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Cox H, Dickson-Hall L, Ndjeka N, van't Hoog A, Grant A, Cobelens F, et al. (2017) Delays and loss to follow-up before treatment of drug-resistant tuberculosis following implementation of Xpert MTB/RIF in South Africa: A retrospective cohort study. PLoS Med 14(2): e1002238. doi:10.1371/journal.pmed.1002238</rights><rights>2017 Cox et al 2017 Cox et al</rights><rights>2017 Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Cox H, Dickson-Hall L, Ndjeka N, van't Hoog A, Grant A, Cobelens F, et al. (2017) Delays and loss to follow-up before treatment of drug-resistant tuberculosis following implementation of Xpert MTB/RIF in South Africa: A retrospective cohort study. PLoS Med 14(2): e1002238. doi:10.1371/journal.pmed.1002238</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c764t-643caf2965f88d45ad79019856643e91c05db0abfd293b3a032021b43763d5f93</citedby><cites>FETCH-LOGICAL-c764t-643caf2965f88d45ad79019856643e91c05db0abfd293b3a032021b43763d5f93</cites><orcidid>0000-0002-4367-1133 ; 0000-0002-2437-5195 ; 0000-0002-6358-0394</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5319645/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5319645/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28222095$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Suthar, Amitabh Bipin</contributor><creatorcontrib>Cox, Helen</creatorcontrib><creatorcontrib>Dickson-Hall, Lindy</creatorcontrib><creatorcontrib>Ndjeka, Norbert</creatorcontrib><creatorcontrib>Van't Hoog, Anja</creatorcontrib><creatorcontrib>Grant, Alison</creatorcontrib><creatorcontrib>Cobelens, Frank</creatorcontrib><creatorcontrib>Stevens, Wendy</creatorcontrib><creatorcontrib>Nicol, Mark</creatorcontrib><title>Delays and loss to follow-up before treatment of drug-resistant tuberculosis following implementation of Xpert MTB/RIF in South Africa: A retrospective cohort study</title><title>PLoS medicine</title><addtitle>PLoS Med</addtitle><description>South Africa has a large burden of rifampicin-resistant tuberculosis (RR-TB), with 18,734 patients diagnosed in 2014. The number of diagnosed patients has increased substantially with the introduction of the Xpert MTB/RIF test, used for tuberculosis (TB) diagnosis for all patients with presumptive TB. Routine aggregate data suggest a large treatment gap (pre-treatment loss to follow-up) between the numbers of patients with laboratory-confirmed RR-TB and those reported to have started second-line treatment. We aimed to assess the impact of Xpert MTB/RIF implementation on the delay to treatment initiation and loss to follow-up before second-line treatment for RR-TB across South Africa.
A nationwide retrospective cohort study was conducted to assess second-line treatment initiation and treatment delay among laboratory-diagnosed RR-TB patients. Cohorts, including approximately 300 sequentially diagnosed RR-TB patients per South African province, were drawn from the years 2011 and 2013, i.e., before and after Xpert implementation. Patients with prior laboratory RR-TB diagnoses within 6 mo and currently treated patients were excluded. Treatment initiation was determined through data linkage with national and local treatment registers, medical record review, interviews with health care staff, and direct contact with patients or household members. Additional laboratory data were used to track cases. National estimates of the percentage of patients who initiated treatment and time to treatment were weighted to account for the sampling design. There were 2,508 and 2,528 eligible patients in the 2011 and 2013 cohorts, respectively; 92% were newly diagnosed with RR-TB (no prior RR-TB diagnoses). Nationally, among the 2,340 and 2,311 new RR-TB patients in the 2011 and 2013 cohorts, 55% (95% CI 53%-57%) and 63% (95% CI 61%-65%), respectively, started treatment within 6 mo of laboratory receipt of their diagnostic specimen (p < 0.001). However, in 2013, there was no difference in the percentage of patients who initiated treatment at 6 mo between the 1,368 new RR-TB patients diagnosed by Xpert (62%, 95% CI 59%-65%) and the 943 diagnosed by other methods (64%, 95% CI 61%-67%) (p = 0.39). The median time to treatment decreased from 44 d (interquartile range [IQR] 20-69) in 2011 to 22 d (IQR 2-43) in 2013 (p < 0.001). In 2013, across the nine provinces, there were substantial variations in both treatment initiation (range 51%-73% by 6 mo) and median time to treatment (range 15-36 d, n = 1,450), and only 53% of the 1,448 new RR-TB patients who received treatment were recorded in the national RR-TB register. This retrospective study is limited by the lack of information to assess reasons for non-initiation of treatment, particularly pre-treatment mortality data. Other limitations include the use of names and dates of birth to locate patient-level data, potentially resulting in missed treatment initiation among some patients.
In 2013, there was a large treatment gap for RR-TB in South Africa that varied significantly across provinces. Xpert implementation, while reducing treatment delay, had not contributed substantially to reducing the treatment gap in 2013. However, given improved case detection with Xpert, a larger proportion of RR-TB patients overall have received treatment, with reduced delays. Nonetheless, strategies to further improve linkage to treatment for all diagnosed RR-TB patients are urgently required.</description><subject>Adult</subject><subject>Analysis</subject><subject>Antibiotics, Antitubercular - therapeutic use</subject><subject>Clinical Protocols</subject><subject>Cohort Studies</subject><subject>Diagnosis</subject><subject>Drug resistance</subject><subject>Drug Resistance, Bacterial</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Global health</subject><subject>Health services administration</subject><subject>Humans</subject><subject>Infectious diseases</subject><subject>Laboratories</subject><subject>Male</subject><subject>Medicine and Health Sciences</subject><subject>Microbial drug resistance</subject><subject>Middle Aged</subject><subject>Pathology</subject><subject>Patients</subject><subject>People and places</subject><subject>Physiological aspects</subject><subject>Public health</subject><subject>Research and Analysis Methods</subject><subject>Retrospective Studies</subject><subject>South Africa</subject><subject>Studies</subject><subject>Tuberculosis</subject><subject>Tuberculosis, Multidrug-Resistant - drug therapy</subject><issn>1549-1676</issn><issn>1549-1277</issn><issn>1549-1676</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>DOA</sourceid><recordid>eNqVk8Fu1DAQhiMEoqXwBggsISE4ZGvHcRJzQFoKhZUKldqCuFmOY2ddeeNgO4W-Dw-K002rXbQHkA-Jxt__2zPjSZKnCM4QLtHhpR1cx82sX8lmhiDMMlzdS_YRyWmKirK4v_G_lzzy_jIyFFL4MNnLqizLICX7ye_30vBrD3jXAGO9B8ECZY2xP9OhB7VU1kkQnORhJbsArAKNG9rUSa994DEShlo6MUSt9pNSdy3Qq97IUcKDtt2o-95LF8Dni3eHZ4tjoDtwboewBHPltOBvwBw4GZz1vRRBX0kg7NJG3oehuX6cPFDcePlk-h4kX48_XBx9Sk9OPy6O5iepKIs8pEWOBVcZLYiqqiYnvCkpRLQiRdyRFAlImhryWjUZxTXmEGcwQ3WOywI3RFF8kDxf-_YxHTYV2DNUlRUsUUnLSCzWRGP5JeudXnF3zSzX7CZgXcu4C1oYyfIKVxgTWnIl8qKqORpXngtFOFGERK-302lDHXsoYrEcN1um2zudXrLWXjGCES3y0eDVZODsj0H6wFbaC2kM76Qdbu4NaVWUVR7RF3-hu7ObqJbHBHSnbDxXjKZsntNYJkSKsUrpDqqVnYyXtJ1UOoa3-NkOPq5GrrTYKXi9JYhMkL9Cywfv2eL87D_YL__Onn7bZl9usEvJTVh6a4bxNfttMF-DIj5e76S6ayCCbBzU20qzcVDZNKhR9myz-Xei28nEfwB_kzkI</recordid><startdate>20170221</startdate><enddate>20170221</enddate><creator>Cox, Helen</creator><creator>Dickson-Hall, Lindy</creator><creator>Ndjeka, Norbert</creator><creator>Van't Hoog, Anja</creator><creator>Grant, Alison</creator><creator>Cobelens, Frank</creator><creator>Stevens, Wendy</creator><creator>Nicol, Mark</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISN</scope><scope>ISR</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><scope>CZK</scope><orcidid>https://orcid.org/0000-0002-4367-1133</orcidid><orcidid>https://orcid.org/0000-0002-2437-5195</orcidid><orcidid>https://orcid.org/0000-0002-6358-0394</orcidid></search><sort><creationdate>20170221</creationdate><title>Delays and loss to follow-up before treatment of drug-resistant tuberculosis following implementation of Xpert MTB/RIF in South Africa: A retrospective cohort study</title><author>Cox, Helen ; Dickson-Hall, Lindy ; Ndjeka, Norbert ; Van't Hoog, Anja ; Grant, Alison ; Cobelens, Frank ; Stevens, Wendy ; Nicol, Mark</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c764t-643caf2965f88d45ad79019856643e91c05db0abfd293b3a032021b43763d5f93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Analysis</topic><topic>Antibiotics, Antitubercular - therapeutic use</topic><topic>Clinical Protocols</topic><topic>Cohort Studies</topic><topic>Diagnosis</topic><topic>Drug resistance</topic><topic>Drug Resistance, Bacterial</topic><topic>Drug therapy</topic><topic>Female</topic><topic>Global health</topic><topic>Health services administration</topic><topic>Humans</topic><topic>Infectious diseases</topic><topic>Laboratories</topic><topic>Male</topic><topic>Medicine and Health Sciences</topic><topic>Microbial drug resistance</topic><topic>Middle Aged</topic><topic>Pathology</topic><topic>Patients</topic><topic>People and places</topic><topic>Physiological aspects</topic><topic>Public health</topic><topic>Research and Analysis Methods</topic><topic>Retrospective Studies</topic><topic>South Africa</topic><topic>Studies</topic><topic>Tuberculosis</topic><topic>Tuberculosis, Multidrug-Resistant - drug therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cox, Helen</creatorcontrib><creatorcontrib>Dickson-Hall, Lindy</creatorcontrib><creatorcontrib>Ndjeka, Norbert</creatorcontrib><creatorcontrib>Van't Hoog, Anja</creatorcontrib><creatorcontrib>Grant, Alison</creatorcontrib><creatorcontrib>Cobelens, Frank</creatorcontrib><creatorcontrib>Stevens, Wendy</creatorcontrib><creatorcontrib>Nicol, Mark</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Opposing Viewpoints in Context (Gale)</collection><collection>Gale In Context: Canada</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><collection>PLoS Medicine</collection><jtitle>PLoS medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cox, Helen</au><au>Dickson-Hall, Lindy</au><au>Ndjeka, Norbert</au><au>Van't Hoog, Anja</au><au>Grant, Alison</au><au>Cobelens, Frank</au><au>Stevens, Wendy</au><au>Nicol, Mark</au><au>Suthar, Amitabh Bipin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Delays and loss to follow-up before treatment of drug-resistant tuberculosis following implementation of Xpert MTB/RIF in South Africa: A retrospective cohort study</atitle><jtitle>PLoS medicine</jtitle><addtitle>PLoS Med</addtitle><date>2017-02-21</date><risdate>2017</risdate><volume>14</volume><issue>2</issue><spage>e1002238</spage><epage>e1002238</epage><pages>e1002238-e1002238</pages><issn>1549-1676</issn><issn>1549-1277</issn><eissn>1549-1676</eissn><abstract>South Africa has a large burden of rifampicin-resistant tuberculosis (RR-TB), with 18,734 patients diagnosed in 2014. The number of diagnosed patients has increased substantially with the introduction of the Xpert MTB/RIF test, used for tuberculosis (TB) diagnosis for all patients with presumptive TB. Routine aggregate data suggest a large treatment gap (pre-treatment loss to follow-up) between the numbers of patients with laboratory-confirmed RR-TB and those reported to have started second-line treatment. We aimed to assess the impact of Xpert MTB/RIF implementation on the delay to treatment initiation and loss to follow-up before second-line treatment for RR-TB across South Africa.
A nationwide retrospective cohort study was conducted to assess second-line treatment initiation and treatment delay among laboratory-diagnosed RR-TB patients. Cohorts, including approximately 300 sequentially diagnosed RR-TB patients per South African province, were drawn from the years 2011 and 2013, i.e., before and after Xpert implementation. Patients with prior laboratory RR-TB diagnoses within 6 mo and currently treated patients were excluded. Treatment initiation was determined through data linkage with national and local treatment registers, medical record review, interviews with health care staff, and direct contact with patients or household members. Additional laboratory data were used to track cases. National estimates of the percentage of patients who initiated treatment and time to treatment were weighted to account for the sampling design. There were 2,508 and 2,528 eligible patients in the 2011 and 2013 cohorts, respectively; 92% were newly diagnosed with RR-TB (no prior RR-TB diagnoses). Nationally, among the 2,340 and 2,311 new RR-TB patients in the 2011 and 2013 cohorts, 55% (95% CI 53%-57%) and 63% (95% CI 61%-65%), respectively, started treatment within 6 mo of laboratory receipt of their diagnostic specimen (p < 0.001). However, in 2013, there was no difference in the percentage of patients who initiated treatment at 6 mo between the 1,368 new RR-TB patients diagnosed by Xpert (62%, 95% CI 59%-65%) and the 943 diagnosed by other methods (64%, 95% CI 61%-67%) (p = 0.39). The median time to treatment decreased from 44 d (interquartile range [IQR] 20-69) in 2011 to 22 d (IQR 2-43) in 2013 (p < 0.001). In 2013, across the nine provinces, there were substantial variations in both treatment initiation (range 51%-73% by 6 mo) and median time to treatment (range 15-36 d, n = 1,450), and only 53% of the 1,448 new RR-TB patients who received treatment were recorded in the national RR-TB register. This retrospective study is limited by the lack of information to assess reasons for non-initiation of treatment, particularly pre-treatment mortality data. Other limitations include the use of names and dates of birth to locate patient-level data, potentially resulting in missed treatment initiation among some patients.
In 2013, there was a large treatment gap for RR-TB in South Africa that varied significantly across provinces. Xpert implementation, while reducing treatment delay, had not contributed substantially to reducing the treatment gap in 2013. However, given improved case detection with Xpert, a larger proportion of RR-TB patients overall have received treatment, with reduced delays. Nonetheless, strategies to further improve linkage to treatment for all diagnosed RR-TB patients are urgently required.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>28222095</pmid><doi>10.1371/journal.pmed.1002238</doi><orcidid>https://orcid.org/0000-0002-4367-1133</orcidid><orcidid>https://orcid.org/0000-0002-2437-5195</orcidid><orcidid>https://orcid.org/0000-0002-6358-0394</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1549-1676 |
| ispartof | PLoS medicine, 2017-02, Vol.14 (2), p.e1002238-e1002238 |
| issn | 1549-1676 1549-1277 1549-1676 |
| language | eng |
| recordid | cdi_plos_journals_1878071797 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central |
| subjects | Adult Analysis Antibiotics, Antitubercular - therapeutic use Clinical Protocols Cohort Studies Diagnosis Drug resistance Drug Resistance, Bacterial Drug therapy Female Global health Health services administration Humans Infectious diseases Laboratories Male Medicine and Health Sciences Microbial drug resistance Middle Aged Pathology Patients People and places Physiological aspects Public health Research and Analysis Methods Retrospective Studies South Africa Studies Tuberculosis Tuberculosis, Multidrug-Resistant - drug therapy |
| title | Delays and loss to follow-up before treatment of drug-resistant tuberculosis following implementation of Xpert MTB/RIF in South Africa: A retrospective cohort study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-06T21%3A31%3A38IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Delays%20and%20loss%20to%20follow-up%20before%20treatment%20of%20drug-resistant%20tuberculosis%20following%20implementation%20of%20Xpert%20MTB/RIF%20in%20South%20Africa:%20A%20retrospective%20cohort%20study&rft.jtitle=PLoS%20medicine&rft.au=Cox,%20Helen&rft.date=2017-02-21&rft.volume=14&rft.issue=2&rft.spage=e1002238&rft.epage=e1002238&rft.pages=e1002238-e1002238&rft.issn=1549-1676&rft.eissn=1549-1676&rft_id=info:doi/10.1371/journal.pmed.1002238&rft_dat=%3Cgale_plos_%3EA493761569%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1878071797&rft_id=info:pmid/28222095&rft_galeid=A493761569&rft_doaj_id=oai_doaj_org_article_483833597afc468ba1a1a144cf5a5f55&rfr_iscdi=true |