title: Impact of rapid drug susceptibility testing for tuberculosis: program experience in Lima, Peru.
abstract: METHODS
  Programmatic implementation of decentralized rapid drug susceptibility testing (DST) in Lima, Peru.
  
  
  OBJECTIVE
  Pre-post analysis compared time to diagnosis, treatment outcome and survival among patients tested with direct nitrate reductase assay (NRA) vs. indirect conventional  methods.
  
  
  METHODS
  From 2005 to 2009, we prospectively followed all patients referred for DST before (control) and after (intervention) NRA implementation. Among those referred for DST, NRA was used for smear-positive samples of patients with no prior history of multidrug resistance or treatment  for multidrug-resistant tuberculosis (TB). Data were abstracted from patient charts and laboratory registers. Endpoints were favorable outcomes, time to result and time to death.
  
  
  RESULTS
  Of those patients who met the criteria for NRA, 740 underwent NRA and 621 underwent conventional DST.  NRA yielded test results for 78.4% of cases vs. 68.8% for conventional DST (P < 0.0001); the median time to result was 44 vs. 133 days, respectively (adjusted HR 0.64, 95%CI 0.56-0.73). Among individuals without previous anti-tuberculosis treatment, NRA was associated with  a favorable treatment outcome (adjusted OR 1.39, 95%CI 1.01-1.90) and prolonged survival (adjusted HR 0.53, 95%CI 0.31-0.90).
  
  
  CONCLUSIONS
  Direct NRA significantly shortened time to test result and improved treatment outcomes and survival in certain groups.
authors.affiliation: Division of Global Health Equity, and Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. sshin@partners.org
authors.forename: S S
authors.initials: SS
authors.lastname: Shin
authors.forename: L
authors.initials: L
authors.lastname: Asencios
authors.forename: M
authors.initials: M
authors.lastname: Yagui
authors.forename: G
authors.initials: G
authors.lastname: Yale
authors.forename: C
authors.initials: C
authors.lastname: Suárez
authors.forename: J
authors.initials: J
authors.lastname: Bayona
authors.forename: C
authors.initials: C
authors.lastname: Bonilla
authors.forename: O
authors.initials: O
authors.lastname: Jave
authors.forename: C C
authors.initials: CC
authors.lastname: Contreras
authors.forename: S
authors.initials: S
authors.lastname: Atwood
authors.forename: J A
authors.initials: JA
authors.lastname: Blaya
authors.forename: J
authors.initials: J
authors.lastname: Ershova
authors.forename: J P
authors.initials: JP
authors.lastname: Cegielski
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests / Q000379:methods; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D010568:Peru / Q000453:epidemiology; D011446:Prospective Studies; D013183:Sputum / Q000382:microbiology; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis* / Q000382:microbiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents