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The Impact of a Line Probe Assay Based Diagnostic Algorithm on Time to Treatment Initiation and Treatment Outcomes for Multidrug Resistant TB Patients in Arkhangelsk Region, Russia
- Source :
- PloS one, vol 11, iss 4, PLoS ONE, Vol 11, Iss 4, p e0152761 (2016), PLoS ONE
- Publication Year :
- 2016
- Publisher :
- Public Library of Science (PLoS), 2016.
-
Abstract
- BackgroundIn the Arkhangelsk region of Northern Russia, multidrug-resistant (MDR) tuberculosis (TB) rates in new cases are amongst the highest in the world. In 2014, MDR-TB rates reached 31.7% among new cases and 56.9% among retreatment cases. The development of new diagnostic tools allows for faster detection of both TB and MDR-TB and should lead to reduced transmission by earlier initiation of anti-TB therapy.Study aimThe PROVE-IT (Policy Relevant Outcomes from Validating Evidence on Impact) Russia study aimed to assess the impact of the implementation of line probe assay (LPA) as part of an LPA-based diagnostic algorithm for patients with presumptive MDR-TB focusing on time to treatment initiation with time from first-care seeking visit to the initiation of MDR-TB treatment rather than diagnostic accuracy as the primary outcome, and to assess treatment outcomes. We hypothesized that the implementation of LPA would result in faster time to treatment initiation and better treatment outcomes.MethodsA culture-based diagnostic algorithm used prior to LPA implementation was compared to an LPA-based algorithm that replaced BacTAlert and Löwenstein Jensen (LJ) for drug sensitivity testing. A total of 295 MDR-TB patients were included in the study, 163 diagnosed with the culture-based algorithm, 132 with the LPA-based algorithm.ResultsAmong smear positive patients, the implementation of the LPA-based algorithm was associated with a median decrease in time to MDR-TB treatment initiation of 50 and 66 days compared to the culture-based algorithm (BacTAlert and LJ respectively, pConclusionThe results of the study suggest that the introduction of LPA leads to faster time to MDR diagnosis and earlier treatment initiation as well as better treatment outcomes for patients with MDR-TB. These findings also highlight the need for further improvements within the health system to reduce both patient and diagnostic delays to truly optimize the impact of new, rapid diagnostics.
- Subjects :
- Bacterial Diseases
Male
0301 basic medicine
Physiology
Extensively Drug-Resistant Tuberculosis
Treatment outcome
Russia
Geographical Locations
0302 clinical medicine
Tuberculosis, Multidrug-Resistant
Medicine and Health Sciences
Culture conversion
030212 general & internal medicine
screening and diagnosis
Multidisciplinary
Multi-Drug-Resistant Tuberculosis
Applied Mathematics
Simulation and Modeling
Multi-drug-resistant tuberculosis
Multidrug-Resistant
Middle Aged
Body Fluids
Europe
Detection
Infectious Diseases
Physical Sciences
Tuberculosis Diagnosis and Management
Medicine
Female
Anatomy
medicine.symptom
Infection
Algorithm
Algorithms
Research Article
4.2 Evaluation of markers and technologies
Adult
Asia
Tuberculosis
General Science & Technology
Science
030106 microbiology
Time to treatment
Research and Analysis Methods
Vaccine Related
03 medical and health sciences
Rare Diseases
Diagnostic Medicine
Clinical Research
Biodefense
medicine
Humans
business.industry
Prevention
Sputum
Biology and Life Sciences
Extensively drug-resistant tuberculosis
Tropical Diseases
medicine.disease
Clinical trial
Mucus
Emerging Infectious Diseases
Good Health and Well Being
People and Places
Antimicrobial Resistance
business
Mathematics
Subjects
Details
- ISSN :
- 19326203
- Volume :
- 11
- Database :
- OpenAIRE
- Journal :
- PLOS ONE
- Accession number :
- edsair.doi.dedup.....a1d3466dac9776923a555ed237deb39a