Effect of Xpert MTB/RIF testing introduction and favorable outcome predictors for tuberculosis treatment among HIV infected adults in rural southern Mozambique. A retrospective cohort study
Por:
Nacarapa, E, Muchiri, E, Moon, T, Charalambous, S, Verdu, M, Ramos, J and Valverde, E
Publicada:
9 mar 2020
Resumen:
Background
Global roll out of Xpert MTB/RIF technology has resulted in dramatic changes in TB diagnosis. However, benefits in resource-limited, high-burden TB/HIV settings, remain to be verified. In this paper we describe the characteristics of a large cohort of TB patients in a rural hospital in Southern Mozambique before and after Xpert MTB/RIF introduction, together with some determinants of favorable treatment outcome.
Methods
We conducted a retrospective cohort study of TB infected patients >= 15 years of age, diagnosed and treated at Carmelo Hospital of Chokwe between January 1, 2006 and December 31, 2017. Patient demographic and clinical characteristics, and treatment outcomes were recorded and compared before and after Xpert MTB/RIF, which was introduced in the second semester of 2012.
Results
9,655 patients were analyzed, with 44.1% females. HIV testing was conducted in 99.9% of patients, with 82.8% having TB/HIV co-infection. 73.2% of patients had a favorable treatment outcome. No increase was observed in the number of TB patients identified after introduction of Xpert MTB/RIF testing.
Conclusion
Upon introduction, Xpert testing seemed to have a punctual beneficial effect on TB treatment outcomes, however this effect apparently disappeared shortly afterwards. Challenges remain for integration of TB and HIV care, as worse outcomes are reported for those patients diagnosed with TB shortly after starting ART, and also for those never starting ART. The need of reasonably excluding TB disease before ART start should be highlighted to every health care provider engaged in HIV care.
Filiaciones:
Nacarapa, E:
Chokwe Carmelo Hosp Daughters Char, Chokwe, Gaza Province, Mozambique
Vincentian Assoc Fight AIDS & TB, Tinpswalo Assoc, Res Unit, Chokwe, Gaza Province, Mozambique
Muchiri, E:
Aurum Inst, Parktown, South Africa
Moon, T:
Vanderbilt Univ, Med Ctr, Dept Pediat, Div Pediat Infect Dis, Nashville, TN 37232 USA
Vanderbilt Univ, Med Ctr, Vanderbilt Inst Global Hlth, Nashville, TN USA
Charalambous, S:
Aurum Inst, Parktown, South Africa
Univ Witwatersrand, Sch Publ Hlth, Johannesburg, South Africa
Verdu, M:
Chokwe Carmelo Hosp Daughters Char, Chokwe, Gaza Province, Mozambique
:
Univ Gen Hosp Alicante, Dept Internal Med, Alicante, Spain
Miguel Hernandez Univ Elche, Alicante, Spain
Valverde, E:
Aurum Inst, Maputo, Mozambique
Vanderbilt Univ, Med Ctr, Dept Med, Nashville, TN 37232 USA
Green Published, gold
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