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 anti-tuberculosis 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.
Highlights
R E S U LT S : Records from 3658 patients were analysed, 1894 before and 1764 after the introduction of Xpert testing
The proportion initiated on antituberculosis treatment increased from 5.9% (112/1894) to 10.8% (190/1764) (P, 0.01)
The baseline characteristics of presumptive TB patients in both time periods were similar, except for the proportion of presumptive TB patients who had a documented human immunodeficiency virus (HIV)-positive result, which was higher after the implementation of Xpert, probably due to improved HIV testing among presumptive TB patients during this period (Table 1)
Summary
R E S U LT S : 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). 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 : tuberculosis; diagnosis; linkage to treatment
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Schedule a callMore From: The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
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