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

• Main Authors: García-García, José-María, Eliseev, Platon, Balantcev, Grigory, Nikishova, Elena, Gaida, Anastasia, Bogdanova, Elena, Enarson, Donald, Ornstein, Tara, Detjen, Anne, Dacombe, Russell, Gospodarevskaya, Elena, Phillips, Patrick P. J., Mann, Gillian, Squire, Bertie, Mariandyshev, Andrei
• Format: Article in Journal/Newspaper
• Language: English
• Published: Public Library of Science 2016
• Subjects: QW 45 Microbial drug resistance. General or not elsewhere classified; WF 200 Tuberculosis (General); WF 220 Diagnosis. Prognosis; Arkhangelsk
• Online Access: https://archive.lstmed.ac.uk/5840/; http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0152761; https://archive.lstmed.ac.uk/5840/1/PLoS_One_11_4_The%20impact%20of%20a%20line%20probe%20assay.PDF

BACKGROUND: In 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 AIM: The 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. METHODS: A 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. RESULTS: Among 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, p<0.001). In smear negative patients, the LPA-based algorithm was associated with a median decrease in time to MDR-TB treatment initiation of 78 days when compared to the culture-based algorithm (LJ, p<0.001). However, several weeks were still needed for treatment initiation in LPA-based algorithm, 24 days in smear positive, and 62 days in smear negative patients. Overall treatment outcomes were better in LPA-based algorithm ...