title: Effect of universal MODS access on pulmonary tuberculosis treatment outcomes in new patients in Peru.
abstract: METHODS
  Primary health care centres in Callao, Peru.
  
  
  OBJECTIVE
  To evaluate the effect of universal access to the microscopic-observation drug susceptibility (MODS) assay on treatment outcomes in new and primary multidrug-resistant tuberculosis (MDR-TB) patients and on the process of drug susceptibility testing (DST).
  
  
  METHODS
  Retrospective review of tuberculosis (TB) registers and clinical records before (2007) and after (2009) the introduction of MODS in 2008.
  
  
  RESULTS
  There were 281 patients in each cohort. Favourable treatment outcomes for 2007 (81%) and 2009 (77%) cohorts were similar. There was an increase in loss to follow-up (from 6% to 10%,P= 0.04) and a reduction in failure rates (from 4% to 0.4%,P= 0.01) in the 2009 compared with the 2007 cohort. In new MDR-TB cases (n= 22), a favourable treatment outcome was improved (from 46% to 82%,P= 0.183) in the 2009 cohort. DST coverage improved (from 24% to 74%,P< 0.001), and a significant reduction in time to diagnosis of drug-susceptible (from 118 to 33 days,P< 0.001) and MDR-TB (from 158 to 52 days,P=30.003) was observed in the 2009 cohort.
  
  
  CONCLUSIONS
  Universal access to MODS increased DST coverage, reduced the time required to obtain DST results and was associated with reduced failure rates. MODS can make an important contribution to TB management and control in Peru.
authors.affiliation: USAID/Peru Quality Healthcare Project, Lima, Peru.
authors.forename: A
authors.initials: A
authors.lastname: Mendoza-Ticona
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Alarcón
authors.affiliation: Estrategia Sanitaria Nacional de Prevención y Control de la Tuberculosis, Ministerio de Salud, Lima, Peru.
authors.forename: V
authors.initials: V
authors.lastname: Alarcón
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France ; The University of Auckland, Auckland, New Zealand.
authors.forename: K
authors.initials: K
authors.lastname: Bissell
authors.affiliation: Dirección Regional de Salud de Callao, Callao, Peru.
authors.forename: E
authors.initials: E
authors.lastname: Castillo
authors.affiliation: Instituto de Medicina Tropical 'Daniel A. Carrión', Universidad Nacional Mayor de San Marcos, Lima, Peru.
authors.forename: I
authors.initials: I
authors.lastname: Sabogal
authors.affiliation: Dirección Regional de Salud de Callao, Callao, Peru.
authors.forename: J
authors.initials: J
authors.lastname: Mora
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Moore
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
keywords: MDR-TB; MODS; Peru; drug-resistant TB; operational research; rapid test