Geographical Factors in Diagnostic Delay among Multidrug Resistant Tuberculosis Patients

Nunuy Nuraeni; Hendarsyah Suryadinata; Bony Wiem Lestari

Geographical Factors in Diagnostic Delay among Multidrug Resistant Tuberculosis Patients

Nunuy Nuraeni, Hendarsyah Suryadinata, Bony Wiem Lestari

Abstract

Background: Diagnostic delay is a factor that can increase the high burden of multi-drug resistant tuberculosis (MDR-TB). Xpert Mycobacterium tuberculosis/Rifampicin known as Xpert is a rapid diagnostic test to detect MDR-TB. Diagnostic delay defined the duration between a positive result of Acid Fast Bacilli (AFB) smear and positive result of MDR-TB by Xpert examination. This study aimed to compare the analysis of the geographical factors in the diagnostic delay of MDR-TB patients at Dr. Hasan Sadikin General Hospital as the top referral hospital in West Java Indonesia.

Methods: This study was conducted in the period July−December 2016 using cross sectional design. A total of 152 MDR-TB patient data were collected from medical records of MDR-TB patients registered in MDR-TB clinic at Dr. Hasan Sadikin General Hospital in the period 2015−2016. The socio-demographic characteristics were collected and analyzed descriptively The diagnostic delay among MDR-TB patients was analyzed by Mann Whitney test.

Results: Diagnostic delay of MDR-TB patients was 15 days in median, with a minimal and maximal delay of 2−140 days. There was a significant difference of diagnostic delay between patients from Bandung with a median of 9(2-135) days and patients from outside of Bandung with a median of 18(2-140) days, with p<0.01.

Conclusions: MDR-TB patients from outside Bandung have a longer diagnostic delay than patient from Bandung . A further expansion of using Xpert as a rapid diagnostic test for MDR-TB patient is needed.

Keywords

Diagnostic delay, multi-drug resistant tuberculosis, Xpert

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References

WHO. Global Tuberculosis Report 2016. Geneva: World Health Organization; 2016. p. 12–4.

Piatek AS, Cleeff M, Alexander H, Coggin WL, Rehr M, Van Kampen S, et al. GeneXpert for TB diagnosis: planned and purposeful implementation. Glob Health Sci Pract. 2013;1(1):18–23.

Kementerian Kesehatan Republik Indonesia. Laporan Situasi Perkembangan TB MDR di Indonesia Triwulan II Tahun 2015. Jakarta: Kemenkes RI; 2016.

Niemz A, Boyle DS. Nucleic acid testing for tuberculosis at the point-of-care in highburden countries. Expert Rev Mol Diagn. 2012;12(7):687–701.

Van Kampen SC, Susanto NH, Simon S, Astiti SD, Chandra R, Burhan E, et al. Effects of introducing Xpert MTB/RIF on diagnosis and treatment of drug-resistant tuberculosis patients in Indonesia: a pre-post intervention study. PLoS One. 2015;10(6):1–11.

WHO. Xpert MTB/RIF implementation manual: technical and operational “how-to”; practical considerations. Geneva: World Health Organization Press; 2014. p. 1–9.

Li Y, Ehiri J, Tang S, Li D, Bian Y, Lin H, et al. Factors associated with patient, and diagnostic delays in Chinese TB patients : a systematic review and meta-analysis. BMC Med. 2013;11(30):156–61.

Li Y, Ehiri J, Oren E, Hu D, Luo X, Liu Y, et al. Are we doing enough to stem the tide of acquired MDR-TB in countries with high TB burden? Results of a mixed method study in Chongqing, China. PLoS One. 2014;9(2):1–12.

Mulu W, Mekonnen D, Yimer M, Admassu A, Abera B. Risk factors for multidrug resistant tuberculosis patients in Amhara national regional state. Afr Health Sci. 2015;15(2):368–77.

Zhang X, Yin J, Li H, Li S, Walley J, Zou G, et al. Diagnostic and treatment delays of multidrug-resistant tuberculosis before initiating treatment: a cross-sectional study. Trop Med Int Health. 2015;20(11):1431–37.

Mekonnen F, Tessema B, Moges F, Gelaw A, Eshetie S, Kumera G. Multidrug resistant tuberculosis: prevalence and risk factors in districts of metema and west armachiho, Northwest Ethiopia. BMC Infect Dis. 2015;15(1):461–7.

Elmi OS, Hasan H, Abdullah S, Zuki M, Jeab M, Alwi Z Bin, et al. Multidrug-resistant tuberculosis and risk factors associated with its development: a retrospective study. J Infect Dev Ctries. 2015;9(10):1076–85.

Nair SA, Raizada N, Sachdeva KS. Factors associated with tuberculosis and rifampicin-resistant tuberculosis amongst symptomatic patients in India: a retrospective analysis. PLoS One. 2016;11(2):1–9.

Ullah I, Javaid A, Tahir Z, Ullah O, Shah AA. Pattern of drug resistance and risk factors associated with development of drug resistant mycobacterium tuberculosis in Pakistan. PLoS One. 2016;11(1):1–7.

Palomino JC, Martin A. Drug resistance mechanisms in mycobacterium tuberculosis. Antibiotics. 2014;3(3):317–40.