Xpert ® MTB/RIF associated with improved treatment initiation among patients with smear-negative tuberculosis

S. Zawedde-Muyanja, Y. C. Manabe, N. K. Sewankambo, L. Nakiyingi, D. Nakanjako

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Delayed diagnosis and treatment initiation of smear-negative tuberculosis (TB) patients can lead to increased morbidity and mortality, particularly among those co-infected with the human immunodeficiency virus (HIV). OBJECTIVE: To compare TB treatment initiation among smear-negative presumptive TB patients in the 6 months before and after the introduction of Xpert ® MTB/RIF testing at five rural tertiary hospitals in Uganda. METHODS: Patient records of the dates and results of sputum analysis were extracted from TB laboratory registers and linked to those on treatment initiation as indicated in the TB treatment registers. The proportion of smear-negative presumptive patients who initiated anti-tuberculosis treatment was compared before and after Xpert implementation using χ 2 tests. Time to treatment was analysed using Kaplan-Meier survival analysis. RESULTS: Records from 3658 patients were analysed, 1894 before and 1764 after the introduction of Xpert testing. After the introduction of Xpert, 25% (437/ 1764) of smear-negative presumptive TB patients underwent testing. The proportion initiated on antituberculosis treatment increased from 5.9% (112/1894) to 10.8% (190/1764) (P < 0.01). However, 37% (32/ 87) of patients with a confirmed TB diagnosis did not initiate treatment. Time to TB treatment initiation improved from 8 to 3.5 days between the study periods. CONCLUSION: Xpert testing was associated with improved TB treatment initiation among smear-negative presumptive TB patients. Improved utilisation and linkage to treatment could improve the impact of this test on patient-centred outcomes.

Original languageEnglish (US)
Pages (from-to)1475-1480
Number of pages6
JournalInternational Journal of Tuberculosis and Lung Disease
Volume22
Issue number12
DOIs
StatePublished - Dec 1 2018

Keywords

  • Diagnosis
  • Linkage to treatment
  • Tuberculosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases

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