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

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

Research output: Contribution to journalArticle

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 χ2 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

Fingerprint

Tuberculosis
Therapeutics
Rural Hospitals
Uganda
Delayed Diagnosis
Kaplan-Meier Estimate
Survival Analysis
Sputum
Tertiary Care Centers
HIV
Morbidity
Mortality

Keywords

  • Diagnosis
  • Linkage to treatment
  • Tuberculosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases

Cite this

Xpert® MTB/RIF associated with improved treatment initiation among patients with smear-negative tuberculosis. / Zawedde-Muyanja, S.; Manabe, Yukari C; Sewankambo, N. K.; Nakiyingi, L.; Nakanjako, D.

In: International Journal of Tuberculosis and Lung Disease, Vol. 22, No. 12, 01.12.2018, p. 1475-1480.

Research output: Contribution to journalArticle

@article{cea6d8c4979a454d883017f98776e54f,
title = "Xpert{\circledR} MTB/RIF associated with improved treatment initiation among patients with smear-negative tuberculosis",
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{\circledR} 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 χ2 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.",
keywords = "Diagnosis, Linkage to treatment, Tuberculosis",
author = "S. Zawedde-Muyanja and Manabe, {Yukari C} and Sewankambo, {N. K.} and L. Nakiyingi and D. Nakanjako",
year = "2018",
month = "12",
day = "1",
doi = "10.5588/ijtld.17.0460",
language = "English (US)",
volume = "22",
pages = "1475--1480",
journal = "International Journal of Tuberculosis and Lung Disease",
issn = "1027-3719",
publisher = "International Union against Tubercul. and Lung Dis.",
number = "12",

}

TY - JOUR

T1 - Xpert® MTB/RIF associated with improved treatment initiation among patients with smear-negative tuberculosis

AU - Zawedde-Muyanja, S.

AU - Manabe, Yukari C

AU - Sewankambo, N. K.

AU - Nakiyingi, L.

AU - Nakanjako, D.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - 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 χ2 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.

AB - 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 χ2 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.

KW - Diagnosis

KW - Linkage to treatment

KW - Tuberculosis

UR - http://www.scopus.com/inward/record.url?scp=85059498167&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85059498167&partnerID=8YFLogxK

U2 - 10.5588/ijtld.17.0460

DO - 10.5588/ijtld.17.0460

M3 - Article

VL - 22

SP - 1475

EP - 1480

JO - International Journal of Tuberculosis and Lung Disease

JF - International Journal of Tuberculosis and Lung Disease

SN - 1027-3719

IS - 12

ER -