Stepwise implementation of a new diagnostic algorithm for multidrug-resistant tuberculosis in Haiti

Int J Tuberc Lung Dis. 2014 Feb;18(2):220-6. doi: 10.5588/ijtld.13.0513.

Abstract

Setting: The uptake of tests endorsed by the World Health Organization to detect and appropriately confirm multidrug-resistant tuberculosis (MDR-TB) in low-income countries remains insufficient.

Objective: To validate the implementation of line-probe assays (LPA) and liquid culture to develop an algorithm to detect MDR-TB in the challenging setting of Haiti.

Methods: Through an EXPAND-TB (Expanding Access to New Diagnostics for TB) partnership, proficiency testing and validation of 221 acid-fast bacilli positive specimens were performed. Sensitivity, cost and processing time were analysed.

Results: Using liquid vs. solid culture shortened the turnaround time from 54 to 19 days, with a sensitivity of 100% vs. 98.6% and a total cost reduction of 13%. LPA detected all TB and MDR-TB cases at a lower cost than culture, in a mean time of 7.5 days.

Conclusion: The combined use of molecular and liquid culture techniques accelerates the accurate diagnosis of TB and susceptibility testing against first-line drugs in a significantly shorter time, and is less expensive. The implementation of this new algorithm could significantly and accurately improve the screening and treatment follow-up of patients affected with TB and MDR-TB.

Publication types

  • Validation Study

MeSH terms

  • Algorithms*
  • Bacteriological Techniques* / economics
  • Cost-Benefit Analysis
  • Critical Pathways
  • DNA, Bacterial / isolation & purification
  • Developing Countries
  • Haiti
  • Health Care Costs
  • Humans
  • Microbial Sensitivity Tests
  • Molecular Diagnostic Techniques* / economics
  • Mycobacterium tuberculosis / genetics
  • Mycobacterium tuberculosis / isolation & purification*
  • Predictive Value of Tests
  • Reproducibility of Results
  • Sputum / microbiology
  • Time Factors
  • Tuberculosis, Multidrug-Resistant / diagnosis*
  • Tuberculosis, Multidrug-Resistant / drug therapy
  • Tuberculosis, Multidrug-Resistant / economics
  • Tuberculosis, Multidrug-Resistant / microbiology
  • Tuberculosis, Pulmonary / diagnosis*
  • Tuberculosis, Pulmonary / drug therapy
  • Tuberculosis, Pulmonary / economics
  • Tuberculosis, Pulmonary / microbiology

Substances

  • DNA, Bacterial