Effects of Introducing Xpert MTB/RIF on Diagnosis and Treatment of @entity6371 XXXX in Indonesia: A Pre-Post Intervention Study.

@entity1 @entity378 @entity6371 @entity1215
BACKGROUND: In March 2012, the Xpert MTB/RIF assay (Xpert) was introduced in three provincial public hospitals in Indonesia as a novel diagnostic to detect @entity378 and @entity1215 resistance among high risk individuals. OBJECTIVE: This study assessed the effects of using Xpert in place of conventional solid and liquid culture and drug-susceptibility testing on case detection rates, treatment initiation rates, and health system delays among @entity6371 ( @entity378 ) @entity1 . METHODS: Cohort data on registration, test results and treatment initiation were collected from routine presumptive @entity1 registers one year before and one year after Xpert was introduced. Proportions of case detection and treatment initiation were compared using the Pearson Chi square test and median time delays using the Mood's Median test. RESULTS: A total of 975 individuals at risk of @entity6371 were registered in the pre-intervention year and 1,442 in the post-intervention year. After Xpert introduction, @entity378 positivity rate increased by 15%, while @entity1215 resistance rate reduced by 23% among @entity378 positive cases and by 9% among all tested. Second-line @entity378 treatment initiation rate among @entity1215 resistant @entity1 increased by 19%. Time from client registration to diagnosis was reduced by 74 days to a median of a single day (IQR 0-4) and time from diagnosis to treatment start was reduced by 27 days to a median of 15 days (IQR 7-51). All findings were significant with p<0.001. CONCLUSION: Compared to solid and liquid culture and drug-susceptibility testing, Xpert detected more @entity378 and less @entity1215 resistance, increased second-line treatment initiation rates and shortened time to diagnosis and treatment. This test holds promise to improve rapid case finding and management of @entity6371 @entity1 in Indonesia.
