Low implementation of Xpert MTB/RIF among HIV/TB co-infected adults in the International epidemiologic Databases to Evaluate AIDS (IeDEA) program

Autor: Clouse, K., Blevins, M., Lindegren, M.L., Yotebieng, M., Nguyen, D.T., Omondi, A., Michael, D., Zannou, D.M., Carriquiry, G., Pettit, A., IeDEA, Gotuzzo Herencia, José Eduardo, Mejía Cordero, Fernando Alonso
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Bacterial Diseases
Male
antibiotic resistance
Internationality
Databases
Factual
Cross-sectional study
lcsh:Medicine
Human immunodeficiency virus 1
HIV Infections
computer.software_genre
rifampicin
purl.org/pe-repo/ocde/ford#3.03.09 [https]
regression analysis
Geographical Locations
Cohort Studies
0302 clinical medicine
rapid test
Tuberculosis
Multidrug-Resistant
Medicine and Health Sciences
030212 general & internal medicine
lcsh:Science
Multidisciplinary
Database
antiretrovirus agent
Coinfection
Multi-drug-resistant tuberculosis
Multi-Drug-Resistant Tuberculosis
adult
international cooperation
risk assessment
HIV diagnosis and management
lung tuberculosis
cohort analysis
sputum smear
3. Good health
clinical practice
mixed infection
nucleic acid amplification
Infectious Diseases
female
Cohort
bacterium identification
factual database
symbols
Tuberculosis Diagnosis and Management
health program
Female
Health Services Research
CD4 antigen
Cohort study
Research Article
Adult
Tuberculosis
bacterium culture
complication
purl.org/pe-repo/ocde/ford#3.03.08 [https]
information processing
Article
03 medical and health sciences
symbols.namesake
Acquired immunodeficiency syndrome (AIDS)
Diagnostic Medicine
health care access
Human immunodeficiency virus infection
medicine
cross-sectional study
Humans
Poisson regression
human
extrapulmonary tuberculosis
Acquired Immunodeficiency Syndrome
business.industry
lcsh:R
health care facility
CD4 lymphocyte count
medicine.disease
Tropical Diseases
major clinical study
body mass
Health Care
Cross-Sectional Studies
confidence interval
Relative risk
People and Places
Africa
treatment outcome
HIV-1
lcsh:Q
tuberculostatic agent
observational study
business
computer
030217 neurology & neurosurgery
Zdroj: PLoS ONE
PLoS ONE, Vol 12, Iss 2, p e0171384 (2017)
Popis: Objective Xpert MTB/RIF is recommended by the World Health Organization (WHO) as the initial tuberculosis (TB) diagnostic test in individuals suspected of HIV-associated TB. We sought to evaluate field implementation of Xpert among a cohort of HIV/TB co-infected individuals, including availability, utilization and outcomes. Design Observational cohort study (patient-level data) and cross-sectional study (site-level Xpert availability data). Methods Data were collected at 30 participating International epidemiologic Databases to Evaluate AIDS (IeDEA) sites in 18 countries from January 2012-January 2016. All patients were HIV-infected and diagnosed with TB, either bacteriologically or clinically, and followed until a determination of TB treatment outcome. We used multivariable modified Poisson regression to estimate adjusted relative risk (RR) and 95% confidence intervals for unfavorable TB treatment outcomes. Results Most sites (63%) had access to Xpert, either in the clinic (13%), in the same facility (20%) or offsite (30%). Among 2722 HIV/TB patients included, median age was 35.4 years and 41% were female; BMI and CD4 count were low. Overall, most patients (76%) received at least one TB test; 45% were positive. Only 4% of all patients were tested using Xpert: 64% were Xpert-positive, 13% showed rifampicin (RIF) resistance and 30% were extrapulmonary (EPTB) or both pulmonary-EPTB. Treatment outcomes were mostly favorable (77%) and we found little association between Xpert use and an unfavorable TB treatment outcome (RR 1.25, 95%CI: 0.83, 1.90). Conclusions In this cohort, Xpert utilization was low even though the majority of sites had access to the test. Our findings show the need for expanded implementation and further research exploring barriers to use in low-resource settings.
Databáze: OpenAIRE
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