title: Stepwise implementation of a new diagnostic algorithm for multidrug-resistant tuberculosis in Haiti.
abstract: METHODS
  The uptake of tests endorsed by the World Health Organization to detect and appropriately confirm multidrug-resistant tuberculosis (MDR-TB) in low-income countries remains insufficient.
  
  
  OBJECTIVE
  To validate the implementation of line-probe assays (LPA) and liquid culture to develop an algorithm to detect MDR-TB in the challenging setting of Haiti.
  
  
  METHODS
  Through an EXPAND-TB (Expanding Access to New Diagnostics for TB) partnership, proficiency testing and validation of 221 acid-fast bacilli positive specimens were performed. Sensitivity, cost and processing time were analysed.
  
  
  RESULTS
  Using liquid vs. solid culture shortened the turnaround time from 54 to 19 days, with a sensitivity of 100% vs. 98.6% and a total cost reduction of 13%. LPA detected all TB and MDR-TB cases at a lower cost than culture, in a mean time of 7.5 days.
  
  
  CONCLUSIONS
  The combined use of molecular and liquid culture techniques accelerates the accurate diagnosis of TB and susceptibility testing against first-line drugs in a significantly shorter time, and is less expensive. The implementation of this new algorithm could significantly and accurately improve the screening and treatment follow-up of patients affected with TB and MDR-TB.
authors.affiliation: Laboratoire des Pathogènes Emergents, Fondation Mérieux, Lyon, France; Les Centres du Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti.
authors.forename: M
authors.initials: M
authors.lastname: Gauthier
authors.affiliation: Foundation for Innovative New Diagnostics, Geneva, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Somoskövi
authors.affiliation: Laboratoire des Pathogènes Emergents, Fondation Mérieux, Lyon, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Berland
authors.affiliation: Center for Global Health, Weill Cornell Medical College, New York, New York, USA.
authors.forename: O
authors.initials: O
authors.lastname: Ocheretina
authors.affiliation: Les Centres du Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti.
authors.forename: M-M
authors.initials: MM
authors.lastname: Mabou
authors.affiliation: Laboratoire National de Santé Publique, Port-au-Prince, Haiti.
authors.forename: J
authors.initials: J
authors.lastname: Boncy
authors.affiliation: Foundation for Innovative New Diagnostics, Geneva, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Gutierrez
authors.affiliation: Laboratoire des Pathogènes Emergents, Fondation Mérieux, Lyon, France.
authors.forename: G
authors.initials: G
authors.lastname: Vernet
authors.affiliation: Les Centres du Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti; Center for Global Health, Weill Cornell Medical College, New York, New York, USA.
authors.forename: J W
authors.initials: JW
authors.lastname: Pape
mesh_terms: D000465:Algorithms; D001431:Bacteriological Techniques / Q000191:economics; D003362:Cost-Benefit Analysis; D019091:Critical Pathways; D004269:DNA, Bacterial / Q000302:isolation & purification; D003906:Developing Countries; D006205:Haiti; D017048:Health Care Costs; D006801:Humans; D008826:Microbial Sensitivity Tests; D025202:Molecular Diagnostic Techniques / Q000191:economics; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics / Q000382:microbiology
chemical_list: D004269:DNA, Bacterial