title: Effects of introducing Xpert MTB/RIF test on multi-drug resistant tuberculosis diagnosis in KwaZulu-Natal South Africa.
abstract: BACKGROUND
  An algorithm instituted following Xpert MTB/RIF (Xpert) introduction in South Africa advocates for treating all Xpert rifampicin resistant patients as MDR-TB cases while awaiting confirmation by phenotypic or genotypic drug susceptibility testing. This study evaluates how the Xpert has influenced the diagnosis and management of drug resistant TB in the highest burdened district of KwaZulu-Natal Province.
  
  
  METHODS
  Data was retrospectively collected from all patients with rifampicin resistance on Xpert performed between March 2011 and April 2012. Xpert results were compared with those of phenotypic and/genotypic drug susceptibility testing. Patients' records were used to determine the time to treatment initiation.
  
  
  RESULTS
  Out of 637 patients tested by Xpert, 50% had confirmatory results, of which a third were sent on the same day as Xpert test. The rate of rifampicin discordance and monoresistance was 8.8% and 13.4% respectively and there was no difference between phenotypic and genotypic confirmation. Among those who had been initiated on treatment, 28%, 40%, 21% and 8% of patients commenced within 2 weeks, 1 month, 2 months and 3 months of Xpert testing respectively, while the remaining 3% were observed without treatment.
  
  
  CONCLUSIONS
  This study emphasizes the importance of complying with the algorithm in confirming all Xpert rif resistant cases so as to ensure proper management of these patients. Despite the rapidity of the Xpert results, only about 70% of patients had been initiated treatment at one month. Therefore there is a definite need to improve the health systems in order to improve on these delays.
authors.affiliation: Department of Medical Microbiology, University of KwaZulu-Natal, Level 4, Laboratory Building IALCH, Durban, South Africa. Nomonde.Dlamini@nhls.ac.za.
authors.forename: Nomonde R
authors.initials: NR
authors.lastname: Dlamini-Mvelase
authors.forename: Lise
authors.initials: L
authors.lastname: Werner
authors.forename: Rogerio
authors.initials: R
authors.lastname: Phili
authors.forename: Lindiwe P
authors.initials: LP
authors.lastname: Cele
authors.forename: Koleka P
authors.initials: KP
authors.lastname: Mlisana
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D003140:Communicable Disease Control; D003955:Diagnostic Tests, Routine / Q000379:methods; D024881:Drug Resistance, Bacterial; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D012293:Rifampin / Q000494:pharmacology; D012680:Sensitivity and Specificity; D013019:South Africa; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D012293:Rifampin