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Free Content Stepwise implementation of a new diagnostic algorithm for multidrug-resistant tuberculosis in Haiti

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Abstract:

SETTING: The uptake of tests endorsed by the World Health Organization to detect and appropriately confirm multidrug-resistant tuberculosis (MDR-TB) in low-income countries remains insufficient.

OBJECTIVE: To validate the implementation of line-probe assays (LPA) and liquid culture to develop an algorithm to detect MDR-TB in the challenging setting of Haiti.

METHODS: Through an EXPAND-TB (Expanding Access to New Diagnostics for TB) partnership, proficiency testing and validation of 221 acid-fast bacilli positive specimens were performed. Sensitivity, cost and processing time were analysed.

RESULTS: Using liquid vs. solid culture shortened the turnaround time from 54 to 19 days, with a sensitivity of 100% vs. 98.6% and a total cost reduction of 13%. LPA detected all TB and MDR-TB cases at a lower cost than culture, in a mean time of 7.5 days.

CONCLUSION: The combined use of molecular and liquid culture techniques accelerates the accurate diagnosis of TB and susceptibility testing against first-line drugs in a significantly shorter time, and is less expensive. The implementation of this new algorithm could significantly and accurately improve the screening and treatment follow-up of patients affected with TB and MDR-TB.

Keywords: EXPAND-TB; MDR-TB; line-probe assays; liquid culture

Document Type: Research Article

DOI: https://doi.org/10.5588/ijtld.13.0513

Affiliations: 1: Laboratoire des Pathogènes Emergents, Fondation Mérieux, Lyon, France; Les Centres du Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti 2: Foundation for Innovative New Diagnostics, Geneva, Switzerland 3: Laboratoire des Pathogènes Emergents, Fondation Mérieux, Lyon, France 4: Center for Global Health, Weill Cornell Medical College, New York, New York, USA 5: Les Centres du Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti 6: Laboratoire National de Santé Publique, Port-au-Prince, Haiti 7: Les Centres du Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti; Center for Global Health, Weill Cornell Medical College, New York, New York, USA

Publication date: 2014-02-01

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  • 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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