Stepwise implementation of a new diagnostic algorithm for multidrug-resistant tuberculosis in Haiti
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.
Document Type: Research Article
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: February 1, 2014
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