title: Effects of Introducing Xpert MTB/RIF on Diagnosis and Treatment of Drug-Resistant Tuberculosis Patients in Indonesia: A Pre-Post Intervention Study.
abstract: BACKGROUND
  In March 2012, the Xpert MTB/RIF assay (Xpert) was introduced in three provincial public hospitals in Indonesia as a novel diagnostic to detect tuberculosis and rifampicin resistance among high risk individuals.
  
  
  OBJECTIVE
  This study assessed the effects of using Xpert in place of conventional solid and liquid culture and drug-susceptibility testing on case detection rates, treatment initiation rates, and health system delays among drug-resistant tuberculosis (TB) patients.
  
  
  METHODS
  Cohort data on registration, test results and treatment initiation were collected from routine presumptive patient registers one year before and one year after Xpert was introduced. Proportions of case detection and treatment initiation were compared using the Pearson Chi square test and median time delays using the Mood's Median test.
  
  
  RESULTS
  A total of 975 individuals at risk of drug-resistant TB were registered in the pre-intervention year and 1,442 in the post-intervention year. After Xpert introduction, TB positivity rate increased by 15%, while rifampicin resistance rate reduced by 23% among TB positive cases and by 9% among all tested. Second-line TB treatment initiation rate among rifampicin resistant patients increased by 19%. Time from client registration to diagnosis was reduced by 74 days to a median of a single day (IQR 0-4) and time from diagnosis to treatment start was reduced by 27 days to a median of 15 days (IQR 7-51). All findings were significant with p<0.001.
  
  
  CONCLUSIONS
  Compared to solid and liquid culture and drug-susceptibility testing, Xpert detected more TB and less rifampicin resistance, increased second-line treatment initiation rates and shortened time to diagnosis and treatment. This test holds promise to improve rapid case finding and management of drug-resistant TB patients in Indonesia.
authors.affiliation: Access to Laboratory Services Team, KNCV Tuberculosis Foundation, The Hague, the Netherlands.
authors.forename: Sanne C
authors.initials: SC
authors.lastname: van Kampen
authors.affiliation: Medical Faculty, Universitas Padjadjaran, Bandung, Indonesia; Tuberculosis Operational Research Group, Ministry of Health, Jakarta, Indonesia.
authors.forename: Nugroho H
authors.initials: NH
authors.lastname: Susanto
authors.affiliation: Tuberculosis Operational Research Group, Ministry of Health, Jakarta, Indonesia; Medical Faculty, Universitas Atmadjaja, Jakarta, Indonesia.
authors.forename: Sumanto
authors.initials: S
authors.lastname: Simon
authors.affiliation: Tuberculosis Operational Research Group, Ministry of Health, Jakarta, Indonesia.
authors.forename: Shinta D
authors.initials: SD
authors.lastname: Astiti
authors.affiliation: Laboratory Team TB CARE I, KNCV Tuberculosis Foundation, Jakarta, Indonesia.
authors.forename: Roni
authors.initials: R
authors.lastname: Chandra
authors.affiliation: Department of Lung and Respiratory Health, Persahabatan Hospital, Jakarta, Indonesia.
authors.forename: Erlina
authors.initials: E
authors.lastname: Burhan
authors.affiliation: Tuberculosis Operational Research Group, Ministry of Health, Jakarta, Indonesia; Sub-Directorate Statistics and Design, Central Bureau of Statistics, Jakarta, Indonesia.
authors.forename: Muhammad N
authors.initials: MN
authors.lastname: Farid
authors.affiliation: Health Division, United States Agency for International Development, Jakarta, Indonesia.
authors.forename: Kendra
authors.initials: K
authors.lastname: Chittenden
authors.affiliation: National Tuberculosis Control Program, Ministry of Health, Jakarta, Indonesia.
authors.forename: Dyah E
authors.initials: DE
authors.lastname: Mustikawati
authors.affiliation: Medical Faculty, Universitas Padjadjaran, Bandung, Indonesia; Tuberculosis Operational Research Group, Ministry of Health, Jakarta, Indonesia.
authors.forename: Bachti
authors.initials: B
authors.lastname: Alisjahbana
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000904:Antibiotics, Antitubercular / Q000494:pharmacology* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000235:genetics*; D011159:Population Surveillance; D012293:Rifampin / Q000494:pharmacology* / Q000627:therapeutic use; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000904:Antibiotics, Antitubercular; D012293:Rifampin