Your browser doesn't support javascript.
loading
Accelerating access to quality TB care for pediatric TB cases through better diagnostic strategy in four major cities of India.
Raizada, Neeraj; Khaparde, Sunil D; Salhotra, Virender Singh; Rao, Raghuram; Kalra, Aakshi; Swaminathan, Soumya; Khanna, Ashwani; Chopra, Kamal Kishore; Hanif, M; Singh, Varinder; Umadevi, K R; Nair, Sreenivas Achuthan; Huddart, Sophie; Prakash, C H Surya; Mall, Shalini; Singh, Pooja; Saha, B K; Denkinger, Claudia M; Boehme, Catharina; Sarin, Sanjay.
Afiliação
  • Raizada N; Foundation for Innovative New Diagnostics, New Delhi, India.
  • Khaparde SD; Central TB Division, Government of India, New Delhi, India.
  • Salhotra VS; Central TB Division, Government of India, New Delhi, India.
  • Rao R; Central TB Division, Government of India, New Delhi, India.
  • Kalra A; Foundation for Innovative New Diagnostics, New Delhi, India.
  • Swaminathan S; Indian Council of Medical Research, New Delhi, India.
  • Khanna A; State TB office, Govt of NCT, Delhi, India.
  • Chopra KK; New Delhi TB Centre, New Delhi, India.
  • Hanif M; New Delhi TB Centre, New Delhi, India.
  • Singh V; Lady Hardinge Medical College and assoc Kalawati Saran Children's Hospital, New Delhi, India.
  • Umadevi KR; National Institute of research in Tuberculosis, Chennai, India.
  • Nair SA; World Health Organization, Country Office for India, New Delhi, India.
  • Huddart S; McGill University, Montreal, Canada.
  • Prakash CHS; Intermediate Reference Laboratory, Hyderabad, India.
  • Mall S; Foundation for Innovative New Diagnostics, New Delhi, India.
  • Singh P; Foundation for Innovative New Diagnostics, New Delhi, India.
  • Saha BK; Intermediate Reference Laboratory, Kolkata, India.
  • Denkinger CM; Foundation for Innovative New Diagnostics, Geneva, Switzerland.
  • Boehme C; Foundation for Innovative New Diagnostics, Geneva, Switzerland.
  • Sarin S; Foundation for Innovative New Diagnostics, New Delhi, India.
PLoS One ; 13(2): e0193194, 2018.
Article em En | MEDLINE | ID: mdl-29489887
ABSTRACT

BACKGROUND:

Diagnosis of TB in children is challenging, and is largely based on positive history of contact with a TB case, clinical and radiological findings, often without microbiological confirmation. Diagnostic efforts are also undermined by challenges in specimen collection and the limited availability of high sensitivity, rapid diagnostic tests that can be applied with a quick turnaround time. The current project was undertaken in four major cities of India to address TB diagnostic challenges in pediatric population, by offering free of cost Xpert testing to pediatric presumptive TB cases, thereby paving the way for better TB care.

METHODS:

A high throughput lab was established in each of the four project cities, and linked to various health care providers across the city through rapid specimen transportation and electronic reporting linkages. Free Xpert testing was offered to all pediatric (0-14 years) presumptive TB cases (both pulmonary and extra-pulmonary) seeking care at public and private health facilities.

RESULTS:

The current project enrolled 42,238 pediatric presumptive TB cases from April, 2014 to June, 2016. A total of 3,340 (7.91%, CI 7.65-8.17) bacteriologically confirmed TB cases were detected, of which 295 (8.83%, CI 7.9-9.86) were rifampicin-resistant. The level of rifampicin resistance in the project cohort was high. Overall Xpert yielded a high proportion of valid results and TB detection rates were more than three-fold higher than smear microscopy. The project provided same-day testing and early availability of results led to rapid treatment initiation and success rates and very low rates of treatment failure and loss to follow-up.

CONCLUSION:

The current project demonstrated the feasibility of rolling out rapid and upfront Xpert testing for pediatric presumptive TB cases through a single Xpert lab per city in an efficient manner. Rapid turnaround testing time facilitated prompt and appropriate treatment initiation. These results suggest that the upfront Xpert assay is a promising solution to address TB diagnosis in children. The high levels of rifampicin resistance detected in presumptive pediatric TB patients tested under the project are a major cause of concern from a public health perspective which underscores the need to further prioritize upfront Xpert access to this vulnerable population.
Assuntos

Texto completo: 1 Temas: ECOS / Gestao Bases de dados: MEDLINE Assunto principal: Qualidade da Assistência à Saúde / Tuberculose / Acessibilidade aos Serviços de Saúde Tipo de estudo: Clinical_trials / Diagnostic_studies / Observational_studies Aspecto: Determinantes_sociais_saude Limite: Adolescent / Child / Child, preschool / Female / Humans / Infant / Male / Newborn País/Região como assunto: Asia Idioma: En Revista: PLoS One Assunto da revista: CIENCIA / MEDICINA Ano de publicação: 2018 Tipo de documento: Article País de afiliação: Índia

Texto completo: 1 Temas: ECOS / Gestao Bases de dados: MEDLINE Assunto principal: Qualidade da Assistência à Saúde / Tuberculose / Acessibilidade aos Serviços de Saúde Tipo de estudo: Clinical_trials / Diagnostic_studies / Observational_studies Aspecto: Determinantes_sociais_saude Limite: Adolescent / Child / Child, preschool / Female / Humans / Infant / Male / Newborn País/Região como assunto: Asia Idioma: En Revista: PLoS One Assunto da revista: CIENCIA / MEDICINA Ano de publicação: 2018 Tipo de documento: Article País de afiliação: Índia