Impact of scaling up Xpert® MTB/RIF testing for the detection of rifampicin-resistant TB cases in Karachi, Pakistan
OBJECTIVE: To describe a multifaceted case-finding intervention targeting public and private sector health care facilities that used the Xpert assay as a frontline diagnostic test for individuals with presumptive TB, in Karachi, Pakistan, and its impact on case notifications of MDR-TB.
DESIGN: Cross-sectional study.
RESULTS: A total of 51 168 individuals were tested using Xpert, of whom respectively 7581 and 1534 people were diagnosed with TB in the public sector (reverse public-private mix) and private sector (social business model) arms; 574 (6.3% of all TB cases) were identified as having rifampicin (RMP) resistance. A total of 517 (90.1%) people with RMP-resistant TB (RR-TB) identified through the project were initiated on second-line treatment. The intervention resulted in 194 additional cases of RR-TB, an increase of 43% over the baseline.
CONCLUSION: This project, one of the largest Xpert testing programmes conducted at city level, resulted in significantly increased detection and treatment of MDR-TB.
Keywords: private sector; rifampicin resistance; second-line treatment
Document Type: Research Article
Affiliations: 1: Community Health Solutions, Karachi 2: Interactive Research & Development, Karachi, Pakistan 3: London School of Hygiene & Tropical Medicine, London, UK 4: Stop TB Partnership, Geneva, Switzerland
Publication date: 01 August 2018
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