Impact of rapid drug susceptibility testing for tuberculosis: program experience in Lima, Peru

Details

• Alternative Title:
  Int J Tuberc Lung Dis
• Personal Author:
  Shin, S. S. ; Asencios, L. ; Yagui, M. ; Yale, G. ; Suárez, C. ; Bayona, J. ; Bonilla, C. ; Jave, O. ; Contreras, C. C. ; Atwood, S. ; Blaya, J. A. ; Ershova, J. ; Cegielski, J. P.
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• Description:
  Setting ; Programmatic implementation of decentralized rapid drug susceptibility testing (DST) in Lima, Peru. ; Objective ; Pre-post analysis compared time to diagnosis, treatment outcome and survival among patients tested with direct nitrate reductase assay (NRA) vs. indirect conventional methods. ; Design ; From 2005 to 2009, we prospectively followed all patients referred for DST before (control) and after (intervention) NRA implementation. Among those referred for DST, NRA was used for smear-positive samples of patients with no prior history of multidrug resistance or treatment for multidrug-resistant tuberculosis (TB). Data were abstracted from patient charts and laboratory registers. Endpoints were favorable outcomes, time to result and time to death. ; Results ; Of those patients who met the criteria for NRA, 740 underwent NRA and 621 underwent conventional DST. NRA yielded test results for 78.4% of cases vs. 68.8% for conventional DST (P < 0.0001); the median time to result was 44 vs. 133 days, respectively (adjusted HR 0.64, 95%CI 0.56–0.73). Among individuals without previous anti-tuberculosis treatment, NRA was associated with a favorable treatment outcome (adjusted OR 1.39, 95%CI 1.01–1.90) and prolonged survival (adjusted HR 0.53, 95%CI 0.31–0.90). ; Conclusion ; Direct NRA significantly shortened time to test result and improved treatment outcomes and survival in certain groups.
• Keywords:
  • nitrate reductase assay
  • multidrug resistance
  • implementation science
  • clinical outcomes
  • diagnosis
  • Adult
  • Antitubercular Agents
  • Female
  • Humans
  • Male
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• Source:
  Int J Tuberc Lung Dis. 16(11):1538-1543
• Pubmed ID:
  22990138
• Pubmed Central ID:
  PMC5788451
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHSUnited States/ ; K23 AI054591/AI/NIAID NIH HHSUnited States/ ; AI054591-01A2/AI/NIAID NIH HHSUnited States/
• Volume:
  16
• Issue:
  11
• Download URL:
  https://stacks.cdc.gov/view/cdc/51241/cdc_51241_DS1.pdf
• File Type:
  [PDF - 647.00 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:5a4464078a1824b889f333ce893ff7203e0508ed25cad020a7028741fefe8554