Impact of GxAlert on the management of rifampicin-resistant tuberculosis patients, Port Moresby, Papua New Guinea

Abstract

GxAlert is an automatic electronic notification service that provides immediate Xpert® MTB/RIF testing results. It was implemented for the notification of patients with rifampicin resistant-tuberculosis (RR-TB) at Port Moresby General Hospital, Port Moresby, Papua New Guinea, in May 2015. To determine if there were differences in pre-treatment attrition, the time to treatment initiation and patient outcomes in the 12 months pre- and post-introduction of GxAlert for RR-TB patients. This was a retrospective cohort study. The median time from Xpert testing to treatment initiation decreased from 35 days [IQR 13-131] prior to GxAlert to 10 days [IQR 3-29] after GxAlert (P = 0.001), with the cumulative proportion of patients initiating treatment within 30 days increasing from 25% (95%CI 17-37) to 54% (95%CI 44-64; P < 0.001) over these periods. However, our analysis of the time to treatment prior to the introduction of GxAlert suggests that a decrease had already occurred prior to implementation. There was no difference in interim clinical outcomes between the periods. Although a decrease in time to treatment initiation cannot be attributed to GxAlert, there was a significant improvement over the 2-year period, suggesting that considerable improvements have been made in timely RR-TB patient management in Port Moresby.