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Rationing tests for drug-resistant tuberculosis - who are we prepared to miss?

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dc.contributor.author Martin, Laura J.
dc.contributor.author Roper, Martha H.
dc.contributor.author Grandjean, Louis
dc.contributor.author Gilman, Robert Hugh
dc.contributor.author Coronel, Jorge
dc.contributor.author Caviedes, Luz
dc.contributor.author Friedland, Jon S.
dc.contributor.author Moore, David Alexander James
dc.date.accessioned 2019-02-06T14:45:55Z
dc.date.available 2019-02-06T14:45:55Z
dc.date.issued 2016
dc.identifier.uri https://hdl.handle.net/20.500.12866/5118
dc.description.abstract Background: Early identification of patients with drug-resistant tuberculosis (DR-TB) increases the likelihood of treatment success and interrupts transmission. Resource-constrained settings use risk profiling to ration the use of drug susceptibility testing (DST). Nevertheless, no studies have yet quantified how many patients with DR-TB this strategy will miss. Methods: A total of 1,545 subjects, who presented to Lima health centres with possible TB symptoms, completed a clinic-epidemiological questionnaire and provided sputum samples for TB culture and DST. The proportion of drug resistance in this population was calculated and the data was analysed to demonstrate the effect of rationing tests to patients with multidrug-resistant TB (MDR-TB) risk factors on the number of tests needed and corresponding proportion of missed patients with DR-TB. Results: Overall, 147/1,545 (9.5 %) subjects had culture-positive TB, of which 32 (21.8 %) had DR-TB (MDR, 13.6 %; isoniazid mono-resistant, 7.5 %; rifampicin mono-resistant, 0.7 %). A total of 553 subjects (35.8 %) reported one or more MDR-TB risk factors; of these, 506 (91.5 %; 95 % CI, 88.9–93.7 %) did not have TB, 32/553 (5.8 %; 95 % CI, 3.4–8.1 %) had drug-susceptible TB, and only 15/553 (2.7 %; 95 % CI, 1.5–4.4 %) had DR-TB. Rationing DST to those with an MDR-TB risk factor would have missed more than half of the DR-TB population (17/32, 53.2 %; 95 % CI, 34.7–70.9). Conclusions: Rationing DST based on known MDR-TB risk factors misses an unacceptable proportion of patients with drug-resistance in settings with ongoing DR-TB transmission. Investment in diagnostic services to allow universal DST for people with presumptive TB should be a high priority. en_US
dc.language.iso eng
dc.publisher BioMed Central
dc.relation.ispartofseries BMC Medicine
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Health Care Rationing/standards en_US
dc.subject Health Status Disparities en_US
dc.subject Adult en_US
dc.subject Diagnostic Tests, Routine/statistics & numerical data en_US
dc.subject Drug Susceptibility Testing en_US
dc.subject Female en_US
dc.subject Health Resources en_US
dc.subject Health Services Accessibility/standards en_US
dc.subject Humans en_US
dc.subject Male en_US
dc.subject Mass Screening/methods/standards en_US
dc.subject Microbial Sensitivity Tests/statistics & numerical data en_US
dc.subject Microscopic-observation drug-susceptibility assay en_US
dc.subject Middle Aged en_US
dc.subject Multidrug-resistant tuberculosis en_US
dc.subject Mycobacterium tuberculosis/isolation & purification en_US
dc.subject Risk Factors en_US
dc.subject Sputum/microbiology en_US
dc.subject Treatment Outcome en_US
dc.subject Tuberculosis en_US
dc.subject Tuberculosis, Multidrug-Resistant/diagnosis/epidemiology en_US
dc.title Rationing tests for drug-resistant tuberculosis - who are we prepared to miss? en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1186/s12916-016-0576-8
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00
dc.relation.issn 1741-7015


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