TY - JOUR
T1 - Rationing tests for drug-resistant tuberculosis - who are we prepared to miss?
AU - Martin, Laura J.
AU - Roper, Martha H.
AU - Grandjean, Louis
AU - Gilman, Robert H.
AU - Coronel, Jorge
AU - Caviedes, Luz
AU - Friedland, Jon S.
AU - Moore, David A.J.
N1 - Funding Information:
DAJM was supported by Fellowship awards from the Wellcome Trust (064672 and 078067). RHG and LC were supported by a National Institutes of Health– Fogarty–Global Research Training Grant (TW006581). JSF is grateful for support from the Imperial College Biomedical Research Centre. The funders had no role in study design, data collection, analysis, or interpretation, the writing of the report, or the decision to submit the paper for publication.
Publisher Copyright:
© 2016 Martin et al.
PY - 2016
Y1 - 2016
N2 - Background: Early identification of patients with drug-resistant tuberculosis (DR-TB) increases the likelihood of treatment success and interrupts transmission. Resource-constrained settings use risk profiling to ration the use of drug susceptibility testing (DST). Nevertheless, no studies have yet quantified how many patients with DR-TB this strategy will miss. Methods: A total of 1,545 subjects, who presented to Lima health centres with possible TB symptoms, completed a clinic-epidemiological questionnaire and provided sputum samples for TB culture and DST. The proportion of drug resistance in this population was calculated and the data was analysed to demonstrate the effect of rationing tests to patients with multidrug-resistant TB (MDR-TB) risk factors on the number of tests needed and corresponding proportion of missed patients with DR-TB. Results: Overall, 147/1,545 (9.5 %) subjects had culture-positive TB, of which 32 (21.8 %) had DR-TB (MDR, 13.6 %; isoniazid mono-resistant, 7.5 %; rifampicin mono-resistant, 0.7 %). A total of 553 subjects (35.8 %) reported one or more MDR-TB risk factors; of these, 506 (91.5 %; 95 % CI, 88.9-93.7 %) did not have TB, 32/553 (5.8 %; 95 % CI, 3.4-8.1 %) had drug-susceptible TB, and only 15/553 (2.7 %; 95 % CI, 1.5-4.4 %) had DR-TB. Rationing DST to those with an MDR-TB risk factor would have missed more than half of the DR-TB population (17/32, 53.2 %; 95 % CI, 34.7-70.9). Conclusions: Rationing DST based on known MDR-TB risk factors misses an unacceptable proportion of patients with drug-resistance in settings with ongoing DR-TB transmission. Investment in diagnostic services to allow universal DST for people with presumptive TB should be a high priority.
AB - Background: Early identification of patients with drug-resistant tuberculosis (DR-TB) increases the likelihood of treatment success and interrupts transmission. Resource-constrained settings use risk profiling to ration the use of drug susceptibility testing (DST). Nevertheless, no studies have yet quantified how many patients with DR-TB this strategy will miss. Methods: A total of 1,545 subjects, who presented to Lima health centres with possible TB symptoms, completed a clinic-epidemiological questionnaire and provided sputum samples for TB culture and DST. The proportion of drug resistance in this population was calculated and the data was analysed to demonstrate the effect of rationing tests to patients with multidrug-resistant TB (MDR-TB) risk factors on the number of tests needed and corresponding proportion of missed patients with DR-TB. Results: Overall, 147/1,545 (9.5 %) subjects had culture-positive TB, of which 32 (21.8 %) had DR-TB (MDR, 13.6 %; isoniazid mono-resistant, 7.5 %; rifampicin mono-resistant, 0.7 %). A total of 553 subjects (35.8 %) reported one or more MDR-TB risk factors; of these, 506 (91.5 %; 95 % CI, 88.9-93.7 %) did not have TB, 32/553 (5.8 %; 95 % CI, 3.4-8.1 %) had drug-susceptible TB, and only 15/553 (2.7 %; 95 % CI, 1.5-4.4 %) had DR-TB. Rationing DST to those with an MDR-TB risk factor would have missed more than half of the DR-TB population (17/32, 53.2 %; 95 % CI, 34.7-70.9). Conclusions: Rationing DST based on known MDR-TB risk factors misses an unacceptable proportion of patients with drug-resistance in settings with ongoing DR-TB transmission. Investment in diagnostic services to allow universal DST for people with presumptive TB should be a high priority.
KW - Drug Susceptibility Testing
KW - Microscopic-observation drug-susceptibility assay
KW - Multidrug-resistant tuberculosis
KW - Tuberculosis
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U2 - 10.1186/s12916-016-0576-8
DO - 10.1186/s12916-016-0576-8
M3 - Article
C2 - 27005771
AN - SCOPUS:85007453057
SN - 1741-7015
VL - 14
JO - BMC medicine
JF - BMC medicine
IS - 1
M1 - 30
ER -