Added Value of Comprehensive Program to Provide Universal Access to Care for Sputum Smear-Negative Drug-Resistant Tuberculosis, China.

Fei Huang,Hui Zhang,Wei Lu,Yan Qu,You Li,Lixia Wang,Shitong Huan,Frank Cobelens,Susan Van Den Hof,Tianhua Zhang,Miaomiao Sun,Daniel P Chin,Shuangyi Hou

doi:10.3201/eid2507.181417

Abstract

The increase in drug-resistant tuberculosis in China calls for scaling up rapid diagnosis. We evaluated introduction of rapid resistance testing by line-probe assay for all patients with a diagnosis of pulmonary tuberculosis in 2 prefectures in middle and eastern China. We analyzed sputum samples for smear-positive patients and cultures for smear-negative patients. We used a before–after comparison of baseline and intervention periods (12 months each) and analyzed data for 5,222 baseline period patients and 4,364 intervention period patients. The number of patients with rifampin resistance increased from 30 in the baseline period to 97 in the intervention period for smear-positive patients and from 0 to 13 for smear-negative patients, reflecting a low proportion of positive cultures (410/2,844, 14.4%). Expanding rapid testing for drug resistance for smear-positive patients resulted in a 3-fold increase in patients with diagnoses of rifampin-resistant tuberculosis. However, testing smear-negative patients had limited added value because of a low culture-positive rate.

Highlights

The increase in drug-resistant tuberculosis in China calls for scaling up rapid diagnosis
1 hospital was designated for diagnosis and treatment of rifampin-resistant TB and equipped with the Genechip line-probe assay (LPA; CapitaBio, http://www. capitalbiotech.com) for rapid molecular testing for isoniazid and rifampin resistance for all patients given a diagnosis of smear-positive pulmonary TB, rather than only those for whom rifampin-resistant TB was suspected
A total of 4,553 pulmonary TB patients were reported during the intervention period and 5,269 during the baseline period

Summary

Introduction

The increase in drug-resistant tuberculosis in China calls for scaling up rapid diagnosis. Expanding rapid testing for drug resistance for smear-positive patients resulted in a 3-fold increase in patients with diagnoses of rifampin-resistant tuberculosis. Collaborative mechanisms between the hospital, the local Center for Disease Control (CDC), and community health centers were set up to avoid loss of patients, specimens, and information as patients moved among these facilities These pilot studies showed a 10-fold increased number of diagnoses of rifampin-resistant TB, a decrease in time from resistance testing to initiation of second-line treatment (by 90%), and an increased retention in treatment by 6 months, from 8% to 80% [3]. Because sputum cultures were not routinely performed in China, rapid resistance testing in the first phase of the program was limited to smear-positive TB patients

Methods

Results

Conclusion