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Boyd R, Ford N, Padgen P, Cox H. Time to treatment for rifampicin-resistant tuberculosis: systematic review and meta-analysis. Int J Tuberc Lung Dis 2017; 21:1173-1180. [PMID: 29037299 PMCID: PMC5644740 DOI: 10.5588/ijtld.17.0230] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/25/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND To reduce transmission and improve patient outcomes, rapid diagnosis and treatment of rifampicin-resistant tuberculosis (RR-TB) is required. OBJECTIVE To conduct a systematic review and meta-analysis assessing time to treatment for RR-TB and variability using diagnostic testing methods and treatment delivery approach. DESIGN Studies from 2000 to 2015 reporting time to second-line treatment initiation were selected from PubMed and published conference abstracts. RESULTS From 53 studies, 83 cohorts (13 034 patients) were included. Overall weighted mean time to treatment from specimen collection was 81 days (95%CI 70-91), and was shorter with ambulatory (57 days, 95%CI 40-74) than hospital-based treatment (86 days, 95%CI 71-102). Time to treatment was shorter with genotypic susceptibility testing (38 days, 95%CI 27-49) than phenotypic testing (108 days, 95%CI 98-117). The mean percentage of diagnosed patients initiating treatment was 76% (95%CI 70-83, range 25-100). CONCLUSION Time to second-line anti-tuberculosis treatment initiation is extremely variable across studies, and often unnecessarily long. Reduced delays are associated with genotypic testing and ambulatory treatment settings. Routine monitoring of the proportion of diagnosed patients initiating treatment and time to treatment are necessary to identify areas for intervention.
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Affiliation(s)
- R Boyd
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - N Ford
- Centre for Infectious Disease Research, University of Cape Town, Cape Town, South Africa
| | - P Padgen
- College of Global Public Health, New York University, New York, New York, USA
| | - H Cox
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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Kirwan DE, Ugarte-Gil C, Gilman RH, Caviedes L, Rizvi H, Ticona E, Chavez G, Cabrera JL, Matos ED, Evans CA, Moore DAJ, Friedland JS. Microscopic Observation Drug Susceptibility Assay for Rapid Diagnosis of Lymph Node Tuberculosis and Detection of Drug Resistance. J Clin Microbiol 2016; 54:185-9. [PMID: 26511739 PMCID: PMC4702711 DOI: 10.1128/jcm.02227-15] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/12/2015] [Indexed: 11/20/2022] Open
Abstract
In this study, 132 patients with lymphadenopathy were investigated. Fifty-two (39.4%) were diagnosed with tuberculosis (TB). The microscopic observation drug susceptibility (MODS) assay provided rapid (13 days), accurate diagnosis (sensitivity, 65.4%) and reliable drug susceptibility testing (DST). Despite its lower sensitivity than that of other methods, its faster results and simultaneous DST are advantageous in resource-poor settings, supporting the incorporation of MODS into diagnostic algorithms for extrapulmonary TB.
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Affiliation(s)
- Daniela E Kirwan
- Department of Medical Microbiology, St. George's Hospital, London, United Kingdom Infectious Diseases and Immunity, Imperial College London, London, United Kingdom
| | - Cesar Ugarte-Gil
- Infectious Diseases and Immunity, Imperial College London, London, United Kingdom Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H Gilman
- Department of International Health, Johns Hopkins University, Baltimore, Maryland, USA Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luz Caviedes
- Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hasan Rizvi
- Department of Cellular Pathology, Barts Health NHS Trust, London, United Kingdom
| | - Eduardo Ticona
- Infectious Diseases and Tropical Medicine Unit, Hospital Nacional Dos de Mayo, Lima, Peru Universidad Nacional Mayor de San Marcos, Lima, Peru Universidad de San Martin de Porres, Lima, Peru
| | - Gonzalo Chavez
- Infectious Diseases and Tropical Medicine Unit, Hospital Nacional Dos de Mayo, Lima, Peru
| | - José Luis Cabrera
- Department of Pulmonology, Hospital Daniel Alcides Carrión, Callao, Peru
| | - Eduardo D Matos
- Universidad Nacional Mayor de San Marcos, Lima, Peru Infectious Diseases Unit, Hospital Nacional Arzobispo Loayza, Lima, Peru
| | - Carlton A Evans
- Infectious Diseases and Immunity, and Wellcome Trust Centre for Global Health Research, Imperial College London, London, United Kingdom IFHAD: Innovation for Health and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - David A J Moore
- Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jon S Friedland
- Infectious Diseases and Immunity, Imperial College London, London, United Kingdom
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Yuen CM, Amanullah F, Dharmadhikari A, Nardell EA, Seddon JA, Vasilyeva I, Zhao Y, Keshavjee S, Becerra MC. Turning off the tap: stopping tuberculosis transmission through active case-finding and prompt effective treatment. Lancet 2015; 386:2334-43. [PMID: 26515675 PMCID: PMC7138065 DOI: 10.1016/s0140-6736(15)00322-0] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
To halt the global tuberculosis epidemic, transmission must be stopped to prevent new infections and new cases. Identification of individuals with tuberculosis and prompt initiation of effective treatment to rapidly render them non-infectious is crucial to this task. However, in settings of high tuberculosis burden, active case-finding is often not implemented, resulting in long delays in diagnosis and treatment. A range of strategies to find cases and ensure prompt and correct treatment have been shown to be effective in high tuberculosis-burden settings. The population-level effect of targeted active case-finding on reducing tuberculosis incidence has been shown by studies and projected by mathematical modelling. The inclusion of targeted active case-finding in a comprehensive epidemic-control strategy for tuberculosis should contribute substantially to a decrease in tuberculosis incidence.
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Affiliation(s)
| | | | | | | | | | | | - Yanlin Zhao
- Chinese Centre for Disease Control and Prevention, Beijing, China
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Abstract
The challenge of diagnosing childhood tuberculosis (TB) results from its paucibacillary nature and the difficulties of sputum collection in children. Mycobacterial culture, the diagnostic gold standard, provides microbiological confirmation in only 30% to 40% of childhood pulmonary TB cases and takes up to 6 weeks to result. Conventional drug susceptibility testing requires an additional 2 to 4 weeks after culture confirmation. In response to the low sensitivity and long wait time of the traditional diagnostic approach, many new assays have been developed. These new tools have shortened time to result; however, none of them offer greater sensitivity than culture.
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Affiliation(s)
- Silvia S Chiang
- Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, 1102 Bates Street, Suite 1150, Houston, TX 77030, USA; Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
| | - Douglas S Swanson
- Division of Infectious Diseases, Department of Pediatrics, University of Missouri-Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO 64108, USA
| | - Jeffrey R Starke
- Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, 1102 Bates Street, Suite 1150, Houston, TX 77030, USA.
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