Impact of Xpert MTB/RIF assay on multidrug-resistant tuberculosis treatment outcomes in a health district in South Africa
Date
2019-04
Journal Title
Journal ISSN
Volume Title
Publisher
Health & Medical Publishing Group
Abstract
Background. Xpert MTB/RIF assay rapidly diagnoses rifampicin resistance, enabling early initiation of second-line tuberculosis (TB) treatment. However, the impact of an earlier multidrug-resistant TB (MDR-TB) diagnosis on treatment outcomes is unknown.
Objectives. To compare MDR-TB treatment outcomes in cases diagnosed with smear/culture and Xpert.
Methods. This was a retrospective cohort study with cohorts defined by the diagnostic assay used in presumptive TB cases. Data were extracted from a drug-resistant (DR)-TB register including cases from January 2012 to June 2014. Treatment outcomes were assessed at recorded endpoints or after 2 years for those completing treatment.
Results. A total of 718 cases were enrolled into the study. Cure rates were 43.4% (n=158) for the smear/culture cohort and 33.5% (n=118) for the Xpert cohort (p<0.01). Xpert diagnosis (adjusted risk ratio (aRR) 0.65; p=0.02) and male gender (aRR 0.66; p=0.04) were associated with cure outcome. Xpert diagnosis increased time to sputum culture conversion from 4 to 5 months (log-rank test p=0.01). Time to treatment initiation was not associated with treatment success in logistic regression analysis.
Conclusions. Despite rapid treatment initiation, MDR-TB treatment outcomes were poorer in patients diagnosed with Xpert MTB/RIF assay than in the smear/culture cohort, and they were also poorer in men than in women. Additional studies are required to assess possible factors influencing DR-TB outcomes.
Description
CITATION: Mahwire, T. C., et al. 2019. Impact of Xpert MTB/RIF assay on multidrug-resistant tuberculosis treatment outcomes in a health district in South Africa. South African Medical Journal, 109(4):259-263, doi:10.7196/SAMJ.2019.v109i4.13180.
The original publication is available at http://www.samj.org.za
The original publication is available at http://www.samj.org.za
Keywords
Multidrug-resistant tuberculosis -- Patients -- South Africa, Tuberculosis -- Diagnosis -- South Africa, Tuberculosis -- Treatment
Citation
Mahwire, T. C., et al. 2019. Impact of Xpert MTB/RIF assay on multidrug-resistant tuberculosis treatment outcomes in a health district in South Africa. South African Medical Journal, 109(4):259-263, doi:10.7196/SAMJ.2019.v109i4.13180