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A comparison of multidrug-resistant tuberculosis treatment commencement times in MDRTBPlus line probe assay and XpertH MTB/RIF-based algorithms in a routine operational setting in Cape Town

dc.contributor.authorNaidoo, Prenen_ZA
dc.contributor.authorDu Toit, Elizabethen_ZA
dc.contributor.authorRory Dunbar, Roryen_ZA
dc.contributor.authorLombard, Carlen_ZA
dc.contributor.authorCaldwell, Judyen_ZA
dc.contributor.authorDetjen, Anneen_ZA
dc.contributor.authorSquire, S. Bertelen_ZA
dc.contributor.authorEnarson, Donald A.en_ZA
dc.contributor.authorBeyers, Nuldaen_ZA
dc.date.accessioned2016-03-08T11:51:45Z
dc.date.available2016-03-08T11:51:45Z
dc.date.issued2014-07-31
dc.identifier.citationNaidoo, P. et al. 2014. A comparison of multidrug-resistant tuberculosis treatment commencement times in MDRTBPlus line probe assay and XpertH MTB/RIF-based algorithms in a routine operational setting in Cape Town. PLoS ONE, 9(7):e103328, doi:10.1371/journal.pone.0103328.en_ZA
dc.identifier.issn1932-6203 (online)
dc.identifier.otherdoi:10.1371/journal.pone.0103328
dc.identifier.urihttp://hdl.handle.net/10019.1/98261
dc.descriptionPlease cite as follows: Naidoo, P. et al. 2014. A comparison of multidrug-resistant tuberculosis treatment commencement times in MDRTBPlus line probe assay and XpertH MTB/RIF-based algorithms in a routine operational setting in Cape Town. PLoS ONE, 9(7):e103328, doi:10.1371/journal.pone.0103328.en_ZA
dc.descriptionThe original publication is available at http://journals.plos.org/plosoneen_ZA
dc.description.abstractBackground: Xpert MTB/RIF was introduced as a screening test for all presumptive tuberculosis cases in primary health services in Cape Town, South Africa. Study Aim: To compare multidrug-resistant tuberculosis (MDR-TB) treatment commencement times in MDRTBPlus Line Probe Assay and Xpert MTB/RIF-based algorithms in a routine operational setting. Methods: The study was undertaken in 10 of 29 high tuberculosis burden primary health facilities, selected through stratified random sampling. An observational study was undertaken as facilities transitioned to the Xpert MTB/RIF-based algorithm. MDR-TB diagnostic data were collected from electronic laboratory records and treatment data from clinical records and registers. Kaplan Meier time-to-event analysis was used to compare treatment commencement time, laboratory turnaround time and action delay between algorithms. A facility-level paired analysis was done: the median time-to-event was estimated per facility in each algorithm and mean differences between algorithms compared using a paired t-test. Cox proportional hazards regression was used to assess the effect of patient-level variables on treatment commencement time. The difference between algorithms was compared using the hazard ratio. Results: The median treatment commencement time in the Xpert MTB/RIF-based algorithm was 17 days (95% CI 13 to 22 days), with a median laboratory turnaround time (to result available in the laboratory) of <1 day (95% CI<1 to 1 day). There was a decrease of 25 days (95% CI 17 to 32 days, p<0.001) in median MDR-TB treatment commencement time in the Xpert MTB/RIF-based algorithm. We found no significant effect on treatment commencement times for the patient-level variables assessed. Conclusion: MDR-TB treatment commencement time was significantly reduced in the Xpert MTB/RIF-based algorithm. Changes in the health system may have contributed. However, an unacceptable level of delay remains. Health system and patient factors contributing to delay need to be evaluated and addressed to optimise test benefits.en_ZA
dc.description.urihttp://journals.plos.org/plosone/article?id=10.1371/journal.pone.0103328
dc.format.extent9 pagesen_ZA
dc.language.isoen_ZAen_ZA
dc.publisherPLoSen_ZA
dc.subjectMultidrug-resistant tuberculosisen_ZA
dc.subjectTuberculosis -- Treatmenten_ZA
dc.titleA comparison of multidrug-resistant tuberculosis treatment commencement times in MDRTBPlus line probe assay and XpertH MTB/RIF-based algorithms in a routine operational setting in Cape Townen_ZA
dc.typeArticleen_ZA
dc.description.versionPublisher's versionen_ZA
dc.rights.holderAuthors retain copyrighten_ZA


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