Effects of Xpert® MTB/RIF testing and GxAlert on MDR-TB diagnosis and linkage to care in Mozambique

Abstract

SETTING: The diagnosis of multidrug-resistant tuberculosis (MDR-TB) and gaps in linkage to care are the principal health challenges in Mozambique. Five GeneXpert machines and GxAlert, an eHealth platform, were installed in Sofala and Manica Provinces between 2012 and 2014. OBJECTIVE: To test the effects of Xpert® MTB/RIF testing and GxAlert on rifampin-resistant TB (RR-TB) diagnosis and second-line treatment initiation rates. DESIGN: We conducted a retrospective clinical review of patients with RR-TB from March 2012 to September 2015 at these five sites. Time-series analyses were conducted to investigate the impact of Xpert on case detection and treatment. Pre- and post- analyses were conducted to investigate the impact of GxAlert. RESULTS: A total of 32 182 Xpert tests were conducted: 4010 (12.5%) detected TB without rifampin resistance, and 306 (7.1%) had RR-TB. Of the RR-TB cases, 161 (52.6%) were started on MDR-TB treatment, 6.9% had documented culture results, and time from diagnosis to treatment initiation decreased over time. The absolute number of patients diagnosed and started on MDR-TB treatment increased by 0.26 (95%CI 0.15-0.38, P, 0.001) and 0.16 (95%CI 0.089-0.24, P, 0.001) every 6 months. GxAlert did not affect treatment initiation rates. CONCLUSION: Implementation of Xpert testing was associated with increases in the number of patients diagnosed and started on MDR-TB treatment.