Abstract
In Myanmar, Rifampicin resistant tuberculosis (RR-TB, a proxy for Multi-drug resistant TB) case detection is very low. Our study objectives were to assess the proportion of eligible TB patients who had not undergone RR-TB testing (Xpert-MTB/Rif tests) in Bago Region, Myanmar and to understand the reasons and solutions for non-testing. We conducted a mixed-methods study involving analysis of routinely collected programme data followed by key informant interviews (KIIs) with 32 health care providers. From October 2016 to March 2017, of the 2,331 eligible patients, 1,066 (46%) had not undergone Xpert-MTB/Rif testing. Patients from townships without Xpert-MTB/Rif testing facilities, new TB patients, patients whose HIV status was negative or unknown and extra pulmonary TB patients were less likely to undergo Xpert-MTB/Rif testing. From the health care providers’ perspective, the most common reasons for non-testing were: (a) lack of awareness of the eligibility criteria; (b) difficulties in collecting sputum and transportation from eligible patients to the testing sites. We conclude that nearly half of eligible patients were not tested for RR-TB. Training of health care providers about the latest eligibility criteria and improvement in sputum collection and transportation systems particularly for townships without Xpert-MTB/Rif testing facilities are required to improve RR-TB testing.
Highlights
Multi-drug resistant tuberculosis (MDR-TB), i.e., infection with Mycobacterium tuberculosis that is resistant to the two most potent anti-TB drugs namely, rifampicin and isoniazid, is an important challenge for TB control worldwide
Services for MDR-TB diagnosis and treatment were initiated under the National TB Programme (NTP) in 2009 as a “DOT-Plus” pilot project in 10 townships, which was later renamed as “Programmatic Management of Drug-resistant TB” (PMDT) in 20116
® introduction and scale up of rapid diagnostic tests [Xpert MTB/Rif tests, called ‘GXP tests’ ] and with this test providing results on the presence of Mycobacterium Tuberculosis Complex and rifampicin resistance (RR-TB, rifampicin resistant TB) within 2 hours with relatively high sensitivity and specificity[7], it was expected that the situation would improve
Summary
Multi-drug resistant tuberculosis (MDR-TB), i.e., infection with Mycobacterium tuberculosis that is resistant to the two most potent anti-TB drugs namely, rifampicin and isoniazid, is an important challenge for TB control worldwide. Globally in 2017 only 29% of an estimated 558,000 incident MDR-TB patients were detected and of those detected, 87% were initiated on treatment[1] This indicates that the national tuberculosis programmes in high TB burden countries encounter challenges in the diagnosis and treatment initiation of MDR-TB2. It is recommended that the TB programmes in all high burden countries monitor such attritions, identify the reasons and undertake corrective measures to improve care provided to these patients[4,5]. The diagnosis of MDR-TB was based only on results of sputum culture and drug sensitivity testing This could be done only in two laboratories (located at Yangon and Mandalay), and due to limited access and long turnaround time to obtain results, anecdotal evidence indicates that the number of MDR-TB patients diagnosed and initiated on treatment was low. In order to simplify the case management under routine programmatic conditions, RR-TB patients are considered as proxy for having MDR-TB in Myanmar
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