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Journal Article > Research

Missed opportunities for earlier diagnosis of rifampicin-resistant tuberculosis despite access to Xpert(®) MTB/RIF

Mohr E, Daniels J, Muller O, Furin J, Chabalala B, Steele SJ, Cox V, Dolby T, Ferlazzo G, Shroufi A, Duran LT, Cox HS
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Abstract
OBJECTIVE
To assess the proportion of rifampicin-resistant tuberculosis (RR-TB) patients with potential earlier RR-TB diagnoses in Khayelitsha, South Africa.

DESIGN
We conducted a retrospective analysis among RR-TB patients diagnosed from 2012 to 2014. Patients were considered to have missed opportunities for earlier diagnosis if 1) they were incorrectly screened according to the Western Cape diagnostic algorithm; 2) the first specimen was not tested using Xpert® MTB/RIF; 3) no specimen was ever tested; or 4) the initial Xpert test showed a negative result, but no subsequent specimen was sent for follow-up testing in human immunodeficiency virus-positive patients.

RESULTS
Among 543 patients, 386 (71%) were diagnosed with Xpert and 112 (21%) had had at least one presentation at a health care facility within the 6 months before the presentation at which RR-TB was diagnosed. Overall, 95/543 (18%) patients were screened incorrectly at some point: 48 at diagnostic presentation only, 38 at previous presentation only, and 9 at both previous and diagnostic presentations.

CONCLUSIONS
These data show that a significant proportion of RR-TB patients might have been diagnosed earlier, and suggest that case detection could be improved if diagnostic algorithms were followed more closely. Further training and monitoring is required to ensure the greatest benefit from universal Xpert implementation.
Countries
South Africa
Subject Area
tuberculosisdiagnostics
DOI
10.5588/ijtld.17.0372
Published Date
01-Oct-2017
PubMed ID
28911352
Languages
English
Journal
International Journal of Tuberculosis and Lung Disease
Volume / Issue / Pages
Volume 21, Issue 10, Pages 1100-1105
Issue Date
01-Oct-2017
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