Setting National Institute of Tuberculosis and Respiratory Diseases (erstwhile Lala Ram Sarup Institute) in Delhi, India. Objectives To evaluate before and after the introduction of the line Probe Assay (LPA) a) the overall time to MDR-TB diagnosis and treatment initiation; b) the step-by-step time lapse at each stage of patient management; and c) the lost to follow-up rates. Methods A retrospective cohort analysis was done using data on MDR-TB patients diagnosed during 2009–2012 under Revised National Tuberculosis Control Programme at the institute. Results Following the introduction of the LPA in 2011, the overall median time from identification of patients suspected for MDR-TB to the initiation of treatment was reduced from 157 days (IQR 127–200) to 38 days (IQR 30–79). This reduction was attributed mainly to a lower diagnosis time at the laboratory. Lost to follow-up rates were also significantly reduced after introduction of the LPA (12% versus 39% pre-PLA). Conclusion Introduction of the LPA was associated with a major reduction in the delay between identification of patients suspected for MDR-TB and initiation of treatment, attributed mainly to a reduction in diagnostic time in the laboratory.
References
[1]
World Health Organization, Geneva (2008) Guidelines for the programmatic management of drug-resistant tuberculosis; An emergency update. (WHO/HTM/TB/2008/402).
Narasimooloo R, Ross A (2012) Delay in commencing treatment for MDR TB at a specialised TB treatment centre in KwaZulu-Natal. S Afr Med J 102: 360–362.
[4]
Singla R, Sarin R, Khalid UK, Mathuria K, Singla N, et al. (2009) Seven-year DOTS-Plus pilot experience in India: results, constraints and issues. Int J Tuberc Lung Dis 13: 976–981.
[5]
Central TB Division (2010) DOTS Plus Guidelines, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India.
[6]
Central TB Division (2012) Guidelines on Programmatic Management of Drug Resistant TB (PMDT), Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India.
[7]
World Health Organization. (2011) Global tuberculosis control: WHO report 2011. Geneva: World Health Organization. viii, 246 p.
[8]
Central TB Division, TB India (2012) Directorate General of Helath Services, Ministry of health and Family Welfare, Govt of India.
[9]
Hoek KG, Van Rie A, van Helden PD, Warren RM, Victor TC (2011) Detecting drug-resistant tuberculosis: the importance of rapid testing. Mol Diagn Ther 15: 189–194. doi: 10.1007/bf03256410
[10]
World Health Organization, (2010) Multidrug and Extensively Drug-resistant TB: Global Report on Surveillance and Response. Available: http://whqlibdoc.who.int/publications/20？10/9789241599191_eng.pdf. Accessed 2013 July 12.
[11]
Singhal R, Arora J, Lal P, Bhalla M, Myneeedu VP, et al. (2012) Comparison of line probe assay with liquid culture for rapid detection of multi-drug resistance in Mycobacterium tuberculosis. Indian J Med Res 136: 1044–1047.
[12]
World Health Organization, (2008) Molecular Line Probe Assays for Rapid Screening of Patients at Risk ofMultidrug-resistant Tuberculosis. A Policy Statement. Available: http://www.who.int/tb/laboratory/lpa_pol？icy.pdf. Accessed 2013 July 12.
[13]
Canetti G, Fox W, Khomenko A, Mahler HT, Menon NK, et al. (1969) Advances in techniques of testing mycobacterial drug sensitivity, and the use of sensitivity tests in tuberculosis control programmes. Bull World Health Organ 41: 21–43.
[14]
Somoskovi A, Dormandy J, Mitsani D, Rivenburg J, Salfinger M (2006) Use of smear-positive samples to assess the PCR-based genotype MTBDR assay for rapid, direct detection of the Mycobacterium tuberculosis complex as well as its resistance to isoniazid and rifampin. J Clin Microbiol 44: 4459–4463. doi: 10.1128/jcm.01506-06
[15]
Chadha SS, Sharath BN, Reddy K, Jaju J, Vishnu PH, et al. (2011) Operational challenges in diagnosing multi-drug resistant TB and initiating treatment in Andhra Pradesh, India. PLoS One 6: e26659. doi: 10.1371/journal.pone.0026659
