Abstract

MAHWIRE, Τ C; ZUNZA, M; MARUKUTIRA, Τ  and  NAIDOO, Ρ. Impact of Xpert MTB/RIF assay on multidrug-resistant tuberculosis treatment outcomes in a health district in South Africa. SAMJ, S. Afr. med. j. [online]. 2019, vol.109, n.4, pp.259-263. ISSN 2078-5135.  http://dx.doi.org/10.7196/samj.2019.v109i4.13180.

BACKGROUND: Xpert MTB/RIF assay rapidly diagnoses rifampicin resistance, enabling early initiation of second-line tuberculosis (TB) treatment. However, the impact of an earlier multidrug-resistant TB (MDR-TB) diagnosis on treatment outcomes is unknown OBJECTIVES: To compare MDR-TB treatment outcomes in cases diagnosed with smear/culture and Xpert METHODS: This was a retrospective cohort study with cohorts defined by the diagnostic assay used in presumptive TB cases. Data were extracted from a drug-resistant (DR)-TB register including cases from January 2012 to June 2014. Treatment outcomes were assessed at recorded endpoints or after 2 years for those completing treatment RESULTS: A total of 718 cases were enrolled into the study. Cure rates were 43.4% (n=158) for the smear/culture cohort and 33.5% (n=118) for the Xpert cohort (p<0.01). Xpert diagnosis (adjusted risk ratio (aRR) 0.65;p=0.02) and male gender (aRR 0.66;p=0.04) were associated with cure outcome. Xpert diagnosis increased time to sputum culture conversion from 4 to 5 months (log-rank test p=0.01). Time to treatment initiation was not associated with treatment success in logistic regression analysis CONCLUSIONS: Despite rapid treatment initiation, MDR-TB treatment outcomes were poorer in patients diagnosed with Xpert MTB/RIF assay than in the smear/culture cohort, and they were also poorer in men than in women. Additional studies are required to assess possible factors influencing DR-TB outcomes

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