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. 2016 Mar 23:14:30.
doi: 10.1186/s12916-016-0576-8.

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

Laura J Martin  1   2 , Martha H Roper  3 , Louis Grandjean  3   4   5 , Robert H Gilman  3   6 , Jorge Coronel  3 , Luz Caviedes  3 , Jon S Friedland  4 , David A J Moore  3   5   6
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Rationing tests for drug-resistant tuberculosis - who are we prepared to miss?

Laura J Martin et al. BMC Med. .

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.

Keywords: Drug Susceptibility Testing; Microscopic-observation drug-susceptibility assay; Multidrug-resistant tuberculosis; Tuberculosis.

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Figures

Fig. 1
Fig. 1
Symptomatic patients with multidrug-resistant tuberculosis risk factors for each group
Fig. 2
Fig. 2
Percentages of drug-resistant tuberculosis patients detected by testing strategies
See this image and copyright information in PMC

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