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

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

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

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