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

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Abstract:

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: clinical outcomes; diagnosis; implementation science; multidrug resistance; nitrate reductase assay

Document Type: Research Article

DOI: http://dx.doi.org/10.5588/ijtld.12.0071

Affiliations: 1: Division of Global Health Equity, and Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA 2: Instituto Nacional de Salud, Lima, Peru 3: Instituto Nacional de Salud, Lima, Peru; and Universidad Nacional Mayor de San Marcos, Lima, Peru 4: Dirección de Salud V Lima Ciudad, Lima, Peru 5: Dirección de Salud IV Lima Este, Lima, Peru 6: Socios En Salud, Lima, Peru; and Global Health Programs and Practice, Dartmouth College, Hanover, New Hampshire, USA 7: Ministerio de Salud del Perú, Lima, Peru 8: Socios En Salud, Lima, Peru 9: Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA 10: Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA; e-Health Systems, Santiago, Chile 11: US Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Publication date: November 1, 2012

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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